
2 ~ &- £\ 



Jifttattj of (Eiongtw. 



^cAnttyAt *-=AfL 

UNITED STATES OF AMERICA. 



PHYSICIAN FOR SHIPS; 



CONTAINING 



MEDICAL ADVICE 



SEAMEN AND OTHER PERSONS AT SEA, 



TREATMENT OF DISEASES, 



AND ON THE 



PRESERVATION OF HEALTH 



SICKLY CLIMATES. 

By USHER PARSONS, M. D., 

Late Surgeon in the U. S. Navy, and President of the Rhode Island Medical Society ; Honorary Member 
of the Massachusetts, New Jersey, Philadelphia, and South Carolina Medical Societies. 



THIRD EDITION. 



BOSTON: 
CHARLES C. LITTLE AND JAMES BROWN. 

1842. 









\°L<3 



Entered according to Act of Congress, in the year 1842, by 

Usher Parsons, 

in the Clerk's Office of the District Court of the District of Massachusetts. 






Sold by the publishers, Little & Brown, by Brewers, Stevens & Cush- 
ing, and by Benjamin Loring & Co., Boston ; by William C. Taber, New 
Bedford ; Henry Whipple, Salem ; Joseph Balch, and John A. Wadsworth, 
Providence ; B. C. Baxter, New London; Wiley & Putnam, D. Appleton 
& Co., E. &. G. W. Blunt, and Rushton & Aspinwall, New York. 



boston: 
printed by freeman and bolles, 

- WASHINGTON STREET. 



ADVERTISEMENT 

TO THE SECOND EDITION. 

In publishing a second edition of this book, important 
additions have been made, while its price has been 
reduced nearly one third. 



EXTRACTS 

FROM A REVIEW OF THE WORK, CONTAINED IN THE NEW ENGLAND 
MEDICAL JOURNAL. 

" We trust that this work will meet with an extensive circulation. 
We think it would be an object, well worthy the attention of our 
principal merchants, to introduce it among the masters of vessels 
in their employ. They would, no doubt, find themselves amply 
repaid for the trifling expense to which it would subject them, 
in the greater safety and health of their crews, and the security of 
their own property. With a due observance of the precautions 
and preventives insisted upon in the book of Dr. Parsons, we 
should not so often hear of the extensive and dreadful fatality 
which sometimes befals merchant vessels, and sweeps off one 
after another their whole crews. If the commanders of vessels 
make it their study, as it is their duty, to understand, so far as 
they are capable, its contents, there can be no doubt they might 
arrive at tolerably correct ideas of the nature and treatment of 
those diseases to which seamen are more particularly subject. At 
any rate, they cannot fail of acquiring much very valuable infor- 



IV EXTRACTS FROM THE N. E. MEDICAL JOURNAL. 

mation from the latter part of this volume, with respect to the 
prevention of diseases, a subject which deserves by far the great- 
est portion of their attention. 

"Dr. Parsons has, we think, performed a valuable service to 
the public in this work. His official situation in the service, has 
given him an ample field for experience and observation, and this 
he has improved with great assiduity and intelligence. We find 
constant evidences of a thorough and well grounded knowledge 
of the profession, and a practical acquaintance with all its details. 
Nothing is done for show, or for the purpose of making a display ; 
nothing is out of place ; there is a constant exhibition of accurate 
views of pathology and practice, and, throughout, a careful adap- 
tation of every thing to the capacity and attainments of those for 
whom he has written. The descriptions of diseases are brief and 
perspicuous ; giving, not a medical history of its phenomena and 
its progress, but a view of such of its principal symptoms, as 
would convey a vivid impression to the mind of an unprofessional 
observer. The method of treatment recommended is also of that 
kind, which can best be understood and practised by those for 
whom this work is intended as a guide ; and does not run out into 
those details, nor include those varieties which could only be em- 
barrassing to individuals who are deficient in a medical education. 
We have no hesitation in recommending it to the attention of the 
public, as calculated to do much good, and to supply a deficiency, 
which has been, we doubt not, much felt, and which we are sur- 
prised there has been heretofore no successful attempt to fill." 



ADVERTISEMENT 

TO THE THIRD EDITION. 

The liberal patronage bestowed on the last edition of 
two thousand copies, now all sold, has induced the 
author to spare no pains to render this third one as 
useful as its number of pages would permit. Many 
corrections have been made in every part of the book ; 
much of it has been rewritten, and about one fifth part 
of new matter added, comprising a more extended 
account of the diseases of sickly climates, and one 
entire section on the choice of climate for patients 
laboring under chronic bronchitis and incipient con- 
sumption, showing the comparative value of the places 
usually recommended for such patients, with advice 
and directions for them while travelling by land and 
sea, and during their residence abroad. Several dis- 
eases described and treated, are added to the former 
list, and many new prescriptions and recipes are given. 
The list of medicines recommended for a chest, with 
the requisite quantity according to the number of men 
on board, and the ordinary prices, has been carefully 



VI ADVERTISEMENT. 

revised, and is now adapted to the treatment of dis- 
eases as laid down under their respective heads in the 
book. 

The contents of the medicine chest and the direc- 
tions for treating diseases being thus made to corres- 
pond, the author Avould recommend to captains, who 
intend to consult the book for advice, to have their 
chests put up according to the prescribed list ; they 
will then be sure to find the articles they want, and, 
if guided by the book in prescribing, to avoid the in- 
cumbrance of many others that are useless. This 
advice is not intended, however, to hinder the addition 
of any medicines which the captain, from long use, 
has become attached to. These he can order in addi- 
tion to the list. 

The author would farther recommend to captains 
and mates of vessels to give the book one perusal at 
the commencement of a voyage. They will thereby 
become familiar with its contents, and able to refer to 
it more readily, and perhaps to prescribe by it many 
times from memory. 



INTRODUCTION. 



It may be safely doubted whether attempts to diffuse medical 
science among all classes of people, and make every man his own 
physician, be conducive to the dignity of the medical profession 
or the cause of' humanity. The remark of the poet, that " a little 
learning is a dangerous thing," is particularly true in regard to the 
science of medicine. The danger of tampering with remedies and 
assuming the important prerogatives of the profession, unqualified 
by previous education, appears the more striking, when it is con- 
sidered that a whole life spent in the investigation of disease, is in- 
sufficient to secure one against occasional error in practice. 

What is a little remarkable, popular works on medicine are in 
greatest circulation where they are least necessary, among large 
communities well supplied with physicians, while sailors and such 
as are liable to be out of the reach of physicians, have been quite 
overlooked. Had the authors of Domestic Medicine, Manuals of 
Health, Family Physicians, fyc, bestowed a small share of their labor 
in supplying the forlorn sailor with some directions for relieving his 
pains and preserving his health, when tossing upon the dreary ocean;, 
where no physician can be consulted, human suffering would have 
been lessened, without any interference with the dignity or interests 
of the profession. 

From the want of a few simple directions for setting broken bones, 
and reducing dislocations, sailors are often crippled for life ; often 
the company of transport ships are swept off by the malignant dis- 
eases of sickly climates, that might have been arrested at the very 
onset ; and there is scarce a marine hospital in the country, that does 
not exhibit noseless faces and mutilated bodies, the sad vestiges of a 
long protracted disease, which, with suitable instruction, the patient 
himself might have removed with the greatest facility. These con- 
siderations, and a fear that the subject will continue to be neglected 
by those who are better qualified for writing upon it, have induced 
me to put together the substance of the following pages. 

The diseases are classed into general and local ; the first including 
fevers, scurvy, jaundice, dropsy, dyspepsia, epilepsy, apoplexy, 
lockjaw, small pox, and measles. The second class is subdivided 
into diseases affecting particular portions of the body, as of the head, 
the neck, the chest, &c. &c. This is done with the view to assist 
the sailor in referring to an account of his disease. If ignorant of 
the name of his complaint, and therefore unable to refer to it by the 
index, he certainly cannot be ignorant of the part of his body that 
is disordered, and if it be the head, or neck, &c, he has only to turn 
over the pages till he arrives at the one headed with diseases of that 
part. 



Vlll INTRODUCTION. 

The book being intended exclusively for seafaring people, nautical 
diseases only are included. A great number of complaints, incident 
to the human body, being thus left out, enables the sailor to refer to 
an account of his disorder more readily, at the same time that it les- 
sens the expense of the book. 

In describing the causes, symptoms, and treatment of diseases, 
I have availed myself of the assistance of a variety of authors. In 
giving the symptoms, those only are mentioned, that are most con- 
stant, obvious, and invariable. The pulse, which is the grand index 
to constitutional affections with an experienced physician, is little 
understood by others, and is therefore, referred to in this book in 
such diseases only as where the morbid change it undergoes is 
great, an'd obvious to a common observer. In these diseases it will 
be advisable for the person who prescribes, to compare the pulse of 
the patient with his own, or that of some other healthy person. Any 
unusual frequency, great irregularity, or other deviation from health, 
will then be readily discovered. 

In mentioning the causes of disease, the most common only are 
noticed. A knowledge of these will be attended with the double 
advantage of enabling the patient to determine the character of his 
complaint, and of guarding against their influence in future. 

In directions for the treatment, many valuable remedies are 
omitted ; some, because they would increase the list of articles in a 
medicine-chest, and make its expense objectionable, and others, 
because they would be unsafe in the hands of the inexperienced. 
Thus, arsenic for fever and ague, corrosive sublimate for syphilis, 
and some other complaints, and the concentrated acids in a variety of 
diseases, though very valuable in the hands of a physician, are un- 
safe for others to prescribe, and in the medicine chest of a merchant 
vessel, are even dangerous. 

The exclusion of technical language and the use of the most 
common and hackneyed names of medicines, may give the book a 
vulgar appearance to a well educated physician. To such it may 
be proper to say, that as the work was intended exclusively for the 
perusal and benefit of sailors and common readers, his taste in re- 
spect to style and manner of execution has been the object least 
regarded. 



THE 



PHYSICIAN FOU SHIPS. 



OF INTERMITTENT FEVER, OR FEVER AND AGUE. 



SYMPTOMS. 

It consists of regular fits of fever, between each of 
which, there is a distinct and perfect intermission. The 
fits usually commence in the morning. They recur 
generally every other day — sometimes daily, and in a 
few instances every third day only. 

Each fit consists of three stages, termed the cold, hot 
and sweating- stage, which run their course in this order 
of succession, generally in the space of from three to 
six hours. 

The cold stage commences with languor, sense of 
debility ; yawning and stretching, and aversion to ex- 
ercise. The face and extremities become pale ; the 
skin over the whole body seems constricted, as if cold 
had been applied to it, and resembles goose-flesh. The 
pulse is small, frequent and irregular. At length chills 
come on, with pain in the head, back and loins, fol- 
lowed by universal shaking, and sometimes by vomit- 
ing. 

Hot stage. After a longer or shorter continuance of 
the shaking, the heat of the body gradually returns, at 
first irregularly by transient flashes, soon however be- 
coming steady and intense. There is redness of the 
skin, increase of pain in the head, thirst, a quick, strong 
and hard pulse — sometimes delirium. 
1 



10 INTERMITTENT FEVER. 

Sweating stage. At length a moisture breaks out 
upon the face and neck, which is soon followed by 
universal perspiration. The heat now descends to its 
usual standard, the pulse is diminished in frequency, 
and becomes full and free, and all the other symptoms 
of fever disappear, leaving the patient, however, a lit- 
tle debilitated. 

CAUSES. 

Debility, induced by a poor diet, by great fatigue, 
long watching, depressing passions of the mind, and 
preceding disease. Cold united with moisture, in 
whatever way applied to the body. These, however, 
only predispose to the disease, since a more efficient 
cause is necessary to bring it on ; and this, is exposure 
to marshy exhalations. In proof of this, there are 
large districts of country in which the disease never 
appears, however great the exposure of the inhabit- 
ants to the first mentioned causes ; while there are 
others, having marshes and much stagnant water, in 
which the disease is so common, that in the season of 
it, very few escape an attack, especially those who 
labor under any previous debility. 

TREATMENT. 

The first step in the cure is to cleanse the stomach 
and bowels. This sometimes arrests the disease of 
itself, and always renders the operation of other reme- 
dies more safe and certain. Twenty-five grains of 
ipecac, or four grains of tartar emetic, answer the 
purpose very well, and should be given at the com- 
mencement of the cold stage. During its operation, 
the patient may drink freely of warm water or weak 
chamomile tea. If the emetic fail of acting down- 
wards and clearing the bowels, it should be followed 
by a dose of calomel, four grains, or of blue pill, six 
grains, taken at bed time. 

Having cleared the stomach and bowels, we are to 
commence on the day following with tonics. For- 



INTERMITTENT FEVER. 11 

merly bark and wine were the remedies chiefly relied 
on, assisted sometimes by tincture and decoction of 
bark and other bitters. But since the discovery of the 
essence of bark, in the form of quinine, these more 
disagreeable medicines are laid aside. The quinine 
may be given in doses of two grains, in pills, or dis- 
solved in water, or mixed in molasses or jelly, every 
four hours, during the intermediate day between the 
fits of ague and fever. But on the day following, 
when the attack may be expected, the dose should be 
doubled, and should be taken every two instead of 
every four hours, commencing at sunrise, and continu- 
ing till the time of the expected fit has passed by. 
This course will, in a majority of cases, prevent the 
fever and ague fit entirely, and if it should, we have 
then only to return to two grain doses of quinine, 
and continue them once in four hours for four or 
five days, when with nourishing diet and some mild 
tonic, as elixir vitriol, or decoction of quassia, three 
times a day for two or three days, the patient may be 
considered as cured. 

But should this course fail to prevent the expected 
ague fit on the second day after the emetic, we should 
then give another dose of calomel or blue pill, and 
proceed with a repetition of the same course as before. 

When quinine cannot be procured, or is of a bad 
quality, or has been long used to no effect, other tonic 
bitters are to be substituted, and taken in the same 
manner ; as decoction of bark, columbo, gentian, 
quassia, &c. Also charcoal, finely powdered, may 
be taken in substance. 

Opium has been highly recommended in intermit- 
tents, and well deserves a trial, since its exhibition does 
not interfere with the other remedies above mentioned. 
It may be given in doses of thirty or forty drops of the 
tincture, laudanum, at the commencement of the first 
cold fit, succeeding that in which the emetic was ad- 
ministered. If the first dose fail to induce warmth in 
the space of ten or fifteen minutes, give thirty or forty 



12 REMITTENT FEVER. 

drops more. The tendency of this medicine is to 
shorten the fit and render it less likely to return. 

During the fit, the patient should take freely of warm 
drinks, and during the intervals or between the fits, 
subsist on a nourishing and easily digested food. 

It is of the first importance that sailors, who are 
obliged to wood and water , or perform other duties on 
shore, in situations favorable to the producing of fever 
and ague, should exercise the greatest caution in their 
diet and regimen. As a preventive, it is advisable for 
persons in such situations to drink freely of strong 
coffee, to avoid exposing themselves to sudden changes 
of temperature, or to evening air, and if possible re- 
turn to the ship before dark. They should wear warm 
clothing, indulge in a plentiful diet of flesh highly sea- 
soned ; observe cleanliness, preserve a healthy state of 
the bowels, avoid exercise and all stimulating drinks. 



OF REMITTENT FEVER. 

SYMPTOMS. 

This disease partakes in some degree of the nature 
of intermittent fever, being generally produced by simi- 
lar causes. There is however this difference between 
the two, that in intermittent fever, the fits return 
at stated periods, and on subsiding leave the patient 
entirely free from all febrile symptoms ; while in the 
present disease, there is only an abatement between 
the fits, and an irregularity hi the time of their recur- 
rence. 

It is impossible to describe all the symptoms of re- 
mittent fever, since they vary according to the situation 
and constitution of the patient — the season of the year 
— the treatment adopted, and many other circumstan- 
ces, too numerous to mention. Sometimes bilious 
symptoms predominate, sometimes nervous, and at 
others putrid — nor is it uncommon to find a succes- 



REMITTENT FEVER. 13 

sion of these ; or even a complication of them in the 
same person at the same time. Hence this disease has 
often been termed mixed fever. 

It is most prevalent in warm climates, where great 
heat and moisture rapidly succeed each other — and 
particularly in marshy situations, abounding with wood 
and water. Some eminent writers include under this 
fever, the yellow fever of the West Indies, of New Or- 
leans and Charleston ; also, the Bulam fever, which is 
so destructive of life at the mouth of the Gambia, and 
along the whole coast of Western Africa, from the 
river Senegal to Liberia, and also the fevers of Bengal 
and Batavia, all of which are highly malignant, but the 
propriety of it is doubtful. 

TREATMENT. 

It should be treated according to its predominant 
symptoms, or in the same way as that fever is treated 
to which this at the time bears the nearest resemblance. 
One remedy, however, seems well adapted to every 
form of this, and almost every kind of fever at its com- 
mencement, and that is an emetic. Take thirty grains 
of ipecac, or four grains of tartar emetic ; and, during 
its operation, drink freely of warm water or weak 
chamomile tea, or toast water. 

Should vomiting, however, already have existed in 
any considerable degree, the emetic may be omitted. 

Bleeding is proper in the early stage of the disease, 
provided there be a hard, full pulse, with great heat of 
the skin and severe head-ache. 

A dose of calomel should, in all severe attacks, be 
given early and repeated often, proportioned, however, 
in quantity and frequency of repetition, to the severity 
of the attack. Mild cases of simple remittent, as it 
appears on the Lakes and along the coast of Maryland 
and Virginia, might require a dose of ten to twenty 
grains, once daily, assisted with a little oil or salts, and 
after the operation of the medicine each day, a dose of 
powder of nitre, ten grains, dissolved in a wineglass of 



14 REMITTENT FEVER. 

water, may be given every three hours, alternated with 
a teaspoonfull of spirits of nitre in the same quantity of 
water. One or the other of these medicines taken 
every hour and a half, should be accompanied with the 
free use of cooling drinks. 

Should the pain be severe after the first bleeding, a 
blister may be applied to the back of the neck, and the 
head be constantly wetted with cold water and vine- 
gar. Great heat of the skin, whenever it appears, and 
in whatever part, should be frequently sponged with 
cold water. In the early stage of the fever, great heat 
of the skin may be treated with cold water, dashed on 
the whole surface, copiously. 

In a few days there will be an abatement of the fe- 
ver, and whenever this is perceptible, quinine should 
be given every four hours, beginning with doses of 
about two grains. Should the fever, under this treat- 
ment, assume the intermittent form, which it is liable 
to do in places where the latter prevails, then it is to be 
treated in like manner as directed for that disease. 

Wherever this disease is prevalent, the same preven- 
tives should be taken, and the same regimen adopted, 
as are directed under the head of intermittent fever ; 
as, also, under the head of advice to strangers in hot 
climates. 

This is the most common fever in tropical climates. 
It is not frequent at sea, but generally attacks men 
when they get into harbor, particularly such as are sent 
on the business of wooding and watering, and are thus 
exposed to the noxious effluvia by which it is produced. 
It is of very frequent occurrence in the West Indies — 
on the seaboard and banks of the rivers of the South- 
ern States — on the coast of Guinea in Africa, and the 
warmer latitudes of the East Indies. 

The higher the latitude it occupies, the milder are 
its symptoms. In 1813 it prevailed in the squadron of 
Com. Perry, on the south side of Lake Erie, to such 
an extent, as to attack one man out of four of all the 
crews. Its character, however, was so mild, that one 



LOW TYPHUS, OR SLOW NERVOUS FEVER. 15 

death only occurred. We noticed that changing our 
anchorage from a leeward to a windward shore, or 
sailing out into the middle of the lake, would in two 
days arrest the progress of the disease, and materially 
improve the health of those already sick. 



OF THE LOW TYPHUS, OR SLOW NERVOUS FEVER. 

SYMPTOMS. 

It commences slowly and imperceptibly, with gene- 
ral languor, dejection of mind, loss of appetite, alter- 
nate chills and flushes, duhiess and confusion of thought. 
In a day or two there is a giddiness and pain in the 
head, with aching pains over the whole body, nausea, 
frequent, weak, and often intermitting pulse. At first 
the tongue is moist, but afterwards becomes dry, brown 
and tremulous ; there is little thirst, and the urine is 
pale and watery. As the disease advances, the heat 
and other symptoms of inflammation increase, the urine 
becomes high colored ; sometimes diarrhoea and im- 
moderate sweating ensue ; there is a low, muttering 
delirium, a starting and twitching of the tendons ; 
sometimes a coldness of the extremities, convulsions 
and death. 

CAUSES. 

Weak and delicate habit of body ; poor living ; 
warmth of climate ; depressing passions of the mind, 
as grief, fear, anxiety ; excessive venery, intempe- 
rance. 

It may be known from putrid or malignant fever, by 
the attack being more gradual, and the symptoms 
milder ; from inflammatory fever, by the smallness 
and weakness of the pulse, and by its more mild ac- 
cession. 

About the 7th, 14th, or 21st day from the attack, the 
disease usually abates, and the patient from that time 
slowly recovers. 



16 LOW TYPHUS, OR SLOW NERVOUS FEVER. 



TREATMENT. 

Commence this by cleansing the stomach and bow- 
els with a mild emetic and cathartic combined, as fol- 
lows : 

Take ipecac, thirty grains, and calomel five ; mix 
them, and give the dose in any convenient vehicle. 
Or mix five grains of tartar emetic with two table- 
spoonsful of Epsom in half a pint of water, and give 
a wine glass every half hour till it operates. If this 
fail to move the bowels once or twice, take some 
other mild purgative, and repeat it as often as there is 
the least tendency to costiveness. 

If the disease be not arrested by this treatment with- 
in the first three days, apply blisters to the legs, and 
mustard poultices to the soles of the feet. If after this 
there be much stupor, blister the back of the neck. 

The pulp of an orange, or roasted apples, will be 
both cooling and agreeable to the stomach. 

For common drink, he may take toast- water, lem- 
onade, wine and water, cider, or soda water and thin 
gruel. 

One of the best remedies in the early stage of the 
disease, after the stomach and bowels have been 
moved by medicine, is cold affusions. The cold water 
should be dashed on from a pitcher or bucket, where- 
ever the heat of the skin is above the natural standard. 
If this heat however be confined to particular parts of 
the body, the cold water may be applied to them alone, 
with a sponge or wet cloth. 

The patient should be kept as quiet as possible, and 
with a view to promote perspiration and induce sleep, 
may take every evening a Dover's powder, of ten 
grams, and have warm poultices renewed to his feet. 

During the day-time, administer the following drops : 
— Take spirits nitre and antimonial wine equal parts, 
mix them, and give two tea-spoonfuls every three hours, 
in toast- water. 



PUTRID, MALIGNANT SHIP FEVER. 17 



PUTRID, MALIGNANT SHIP FEVER. 

SYMPTOMS. 

The attack of this disease is very sudden. The pa- 
tient is hardly able to stand, and from the first mo- 
ment seems ready to faint without any apparent cause. 
There is an intense pain in the head, strong pulsa- 
tion and throbbing in the temples — sometimes deliri- 
um — sickness at the stomach, followed by a vomiting 
of black matter. The tongue is at first white, but 
afterwards appears black and chapped, and the teeth 
are covered with a black crust — the breath is hot and 
offensive. The fever continuing to increase still more 
in violence, symptoms of putrefaction show themselves ; 
the stools are dark, very offensive, and pass off insen- 
sibly ; blood is effused under the skin, forming purple 
spots ; bleeding occurs from different parts of the 
body ; the pulse sinks and intermits ; the extremities 
grow cold ; hickups ensue and death. 

This fever may be distinguished from inflammatory, 
by the smallness of the pulse ; — the great dejection 
of mind ; — the sudden and extreme debility ; the pu- 
trid smell of the breath and stools — and by the pur- 
ple spots. It may be known from low or nervous fe- 
ver, by the suddeness and violence of the accession — 
the intensity of heat and thirst, and the high color of 
the urine ; — from yellow fever by the matter vomited 
being void of bile ; by the absence of yellowness in 
the eyes, and by reference to its supposed causes. 

It is however sometimes the case, that this is blend- 
ed with two or three other fevers, particularly the re- 
mittent, when it constitutes the fever of Batavia, Ben- 
gal, and Bencoolen. 

CAUSES. 

The room, or atmosphere in which a person labor- 
ing under the disease is confined ; — foul air, occa- 
sioned by the confinement of a large number of per- 



18 PUTRID, MALIGNANT SHIP FEVER. 

sons in a narrow place not properly ventilated, as in 
crowded hospitals, jails or ships, especially where 
cleanliness is neglected ; — exhalations from putrid 
vegetable or animal substances. Sailors are more 
liable to its attacks in long voyages. 

It is sometimes caused by putrefaction taking place 
in filthy ballast. In the frigate General Greene an 
instance of this kind occurred, and a loss of forty or 
fifty lives was the consequence. The same thing oc- 
curred also on board the frigate Philadelphia. In 
both these instances, the disease was entirely arrested 
by deserting the birth-deck and bringing the crew 
upon the gun and spar-decks, where there was a con- 
stant cm-rent of air. 

This fever is not confined to hot climates, though 
from the more sudden process of putrefaction of ani- 
mal and vegetable matter in warm places, and from 
the debility and consequently greater susceptibility of 
the system to the disease, it oftener appears in hot 
than in cold climates. 

TREATMENT. 

In this disease we should resort to proper remedies 
at the very onset, and not wait until the powers of the 
system are prostrated. The most proper remedy at 
first, in cases of robust frame, will be to open a vein 
as soon as possible, and to give an emetic. But if 
vomiting already exist, omit the emetic, and give 
twenty grains of calomel every six hours, or until it 
acts as physic. With the view of composing the sys- 
tem, combine with each dose of calomel half a grain 
of opium or thirty drops of laudanum. The sooner 
the calomel affects the system the less will be the dan- 
ger of a fatal termination ; and, with the view of hasten- 
ing a salivation, rub mercurial ointment into the inside 
of the thighs, of the size of a nutmeg, every eight 
hours. The calomel, after it has acted as a purgative, 
is to be continued in smaller doses until sore gums are 
induced, from which time there is reason to hope for 
a recovery. 



PUTRID, MALIGNANT SHIP FEVER. 19 

If the surface seems unnaturally hot, apply cold 
water, and vinegar or spirit. 

When three or four doses of calomel have been 
given without any purgative effect, give oil, or salts to 
assist its operation. 

As soon as there is a slight abatement in the vio- 
lence of the fever, give two grains of quinine in solu- 
tion every four hours ; and when the gums are touch- 
ed in the slightest degree with the mercury, stop it for 
a day or two, and give elixir vitriol ten drops in water. 

Support the strength of the patient with the liberal 
use of wine. It may be given in barley, gruel, sago, 
and likewise in his drink. The effervescing mixture 
may be taken every three hours. 

In warm climates, the elixir vitriol, and quassia or 
bark, may be administered as soon as the stomach and 
bowels are cleansed, and without waiting for any re- 
mission. 

Important circumstances to be attended to through- 
out the whole course of this fever, are to cover the 
patient lightly with bed-clothes, to ventilate his apart- 
ment, and sprinkle it with chlorine, vinegar or spirits. 
The bed and body linen should be changed frequently, 
and whenever a motion takes place, let it be removed 
immediately. 

It is of the utmost consequence in this disease to 
procure rest ; and, therefore, where no great delirium 
exists, an opiate may be given toward bed-time, in 
the following manner : 

Take laudanum thirty drops, 
Paragoric sixty, 

Spirits nitre sixty, mixed in warm tea ; or 
give Dover's powder ten grains. 

On the appearance of this, or any infectious disor- 
der, in a garrison, hospital, ship, or other place where 
many persons are crowded together, every apartment 
should not only be cleansed and aired, but fumigated 
daily, with the following preparation : 



20 PUTRID, MALIGNANT SHIP FEVER. 

Put into an earthen vessel a handful of table salt, 
and pour into it sulphuric acid sufficient to mois- 
ten it throughout. Let it remain in the apartment 
half an hour, with the doors and hatches or win- 
dows closed. Or, 

Where this is inconvenient, burn, by means of a hot 
iron, sulphur or gunpowder, previously wet with 
vinegar ; or sprinkle chloride of lime on the floor 
and on the hammock or bed. 

It is proper here to introduce some remarks on the 
nature, and best mode of treatment, of this fever in 
its more malignant form, as it usually appears during 
the sickly season in the ports of the Bay of Bengal, 
and the coast of Malabar from Bombay to Cape Co- 
morin, in Batavia, Bencoolin (in Sumatra), and Bor- 
neo. These remarks were derived chiefly from Drs. 
Clarke and Johnson. 

" The fever attacked in various ways, but common- 
ly began with chills, pain and sickness at stomach, 
vomiting, head-ache, &c. Sometimes, without any 
previous indisposition, the patients fell insensible ; as 
they began to recover from the fit they complained 
sorely of pain in the stomach and head; and after 
vomiting a considerable quantity of bile, they soon re- 
turned to their senses. 

" In whatever form the disease appeared at first, 
the pulse was small, feeble and quick, — the pain at the 
stomach increased, and the vomiting continued. As 
the paroxysm advanced, the countenance became 
flushed, the pulse quick and full, the eyes red, tongue 
furred, thirst intense, head-ache violent, succeeded by 
delirium, and the patient became unmanageable ; but 
a profuse sweat breaking out in twelve or fourteen 
hours generally mitigated all the symptoms. 

" In the remissions, the pulse, which was before fre- 
quently 130, fell to 90. The patient returned to his 
senses, but complained of great debility, sickness at 
stomach, and bitter taste. This interval was very 



PUTRID, MALIGNANT SHIP FEVER. 21 

short, and succeeded by another paroxysm, in which 
all the former symptoms were aggravated, particular- 
ly the thirst, delirium, pain in the stomach, and vomit- 
ing of bile. 

" The unfavorable terminations were generally be- 
tween the third and seventh day. Sometimes there 
was yellowness of the skin, as in common yellow fe- 
ver and black vomit. A torpid or irregular state of 
the bowels commonly preceded this fever." 

TREATMENT. 

The treatment recommended by Dr. Johnson, and 
which the surgeons of our navy have, while in Bengal, 
found most successful, is as follows. First, open a 
vein, and let the blood flow until it relieves the head- 
ache, pain and sickness at the stomach, and vomiting. 
Meanwhile give a dose of 20 grains of calomel, with 
half a grain of opium (or 30 drops of laudanum). 
If this is immediately rejected, the dose may be re- 
peated. This medicine acts like a charm, and after 
a few hours should be followed by a dose of gentle 
physic, castor oil or salts. The more copious the dis- 
charge from the bowels, the less danger there is of a 
return of vomiting. Should the above mentioned 
symptoms return, the bleeding may be repeated. 

Immediately after the operation of the cathartic, 
five grains of calomel should be given every four or 
five hours, combined with the opium, or laudanum, as 
above, until the mouth becomes affected, from which 
time there is great reason to expect a recovery. It is 
of the first importance to affect the gums with the 
mercury as soon as possible, and to this end, if the 
five grain powders do not produce this effect imme- 
diately, we should assist them by rubbing in mercurial 
unction on the inside of the thighs two or three times 
a day. 

The patient should be removed to the most airy 
part of the ship, have his feet bathed frequently with 
warm water, and his head with cold vinegar and wa- 
2 



22 YELLOW FEVER. 

ter. " Generally on the third day," says Dr. John- 
son, " I found the gums affected with mercury, and 
then I felt the patient's danger to be materially les- 
sened." 

Cold water and cold gruel are of service from the 
first, and may be drank freely, unless they excite vom- 
iting. 

Emetics Dr. Johnson condemns in every stage of 
this fever, on account of the great irritability of the 
stomach. When sickness at the stomach has subsided 
and mercurial action commenced, it may be advisable 
to give quinine, one grain twice or thrice a day. He 
does not believe the fever to be contagious, unless pa- 
tients are crowded together, or cleanliness and ventila- 
tion are neglected. 

As a preventive of the disease when vessels he in 
sickly ports, he insists strongly on abstinence from all 
stimulating liquors, on very moderate use of animal 
food, on avoiding exposure to the air on shore in the 
morning and evening, particularly the latter, and ab- 
staining from violent exercise in the sun. If com- 
pelled to wood and ivater in a marshy, noxious atmos- 
phere, the safest hours of the day for it are from 3 to 
6 o'clock in the afternoon. 

As cooler weather approaches, these remittent fe- 
vers of the Bay of Bengal assume an intermittent 
character. 



OF THE YELLOW FEVER. 

SYMPTOMS, 

In general it begins with short alternate chills and 
flushes of heat, seldom, however, with those rigors and 
shakings that mark the commencement of most other 
fevers. These are immediately succeeded by violent 
headache, pain in the back, universal debility, sickness 
and anguish at the stomach. There is commonly, in 



YELLOW FEVER. 23 

the beginning, much bile on the stomach, which is 
thrown off by vomiting, either spontaneous, or excited 
by an emetic. In the course of the disease, however, 
it is not common for the stomach and bowels to be 
loaded with bile ; there is, on the contrary, rather a 
deficiency of it, particularly in the most violent and 
dangerous cases, as is indicated by clay-colored stools. 

The eye in a few hours takes a yellow tinge, which 
soon after extends more or less over the face and 
whole skin. This is a symptom so striking and con- 
stant, that it gives name to the disease. Its first ap- 
pearance on the skin is under the ears. 

One of the most tormenting symptoms is a constant 
wakefulness. It is seldom that even delirium comes 
to the relief of the patient to make him forget himself 
for a moment ; but he continues broad awake, night 
and day, with his reason and senses sound, in a state 
of the most uneasy agitation. 

One distinguishing and alarming symptom is a con- 
stant vomiting, which usually commences within the 
first twenty-four hours, and about the third day ends 
in what is called the black vomit. 

Upon the first attack, the skin is extremely hot and 
dry, but the external heat soon becomes very little 
above the natural standard in health, and the skin feels 
soft and moist. The pulse, which is at first hard and 
frequent, is afterwards so variable as to be no sure in- 
dex of danger. The degree of thirst is less in this 
than in most other fevers, and there is no uniformity 
in the color of the urine. 

Sometimes there is a remission after thirty-six or 
forty-eight hours from the attack, but the symptoms 
often recur with redoubled violence. 

In the latter stage the debility is extremely great, 
and the breath highly offensive ; bleeding sometimes 
occurs from the mouth or nose, the pulse sinks, swal- 
lowing becomes difficult, and death ensues. 



24 YELLOW FEVER. 



CAUSES. 

This disease, though strongly resembling the Bilious 
remittent fever in many of its symptoms, yet differs 
from it in this, that the air of woods and marshes is 
not necessary to produce it. It however often arises 
from the foul air of a ship, either from infectious efflu- 
via, or from putrefaction that takes place in neglected 
holds. A fit of intemperance, or too much exercise in 
the heat of the sun, serves to hasten its attack. 

It is remarkable with regard to it, that it is confined 
almost entirely to those who have recently arrived 
from a cold or temperate climate. It appears also, that 
those persons who have been exposed to unwholesome 
air in the neglected holds of vessels in cold climates, 
are more particularly the subjects of yellow fever, 
when they arrive in a hot climate. Those strangers 
who are young and plethoric are most apt to be at- 
tacked. 

It may be distinguished from Remittent fever, to 
which it bears the nearest resemblance, by reference 
to its causes, as above mentioned. Some writers, 
however, contend that they are identical. 

TREATMENT. 

The mere name of yellow fever is sufficient to damp 
the spirits of sailors, since it occasions more deaths 
among them than all other acute diseases together ; 
and with the exception of plague, the proportion of 
cures is less than in any other disease to which that 
class of people are liable. We should however not 
despond because the fatality of the disease is discour- 
aging, but rather redouble our diligence in observing 
what assistance and relief nature may receive. 

It is proper in all fevers of warm climates to com- 
mence the cure by cleansing the stomach and bowels. 
In yellow fever, however, there is such constant irrita- 
bility of the stomach and inclination to vomit, which 
we find difficult to check, that taking an emetic may 



YELLOW FEVER. 25 

be omitted. During the spontaneous vomiting, that 
occurs early, the patient may drink freely of chamo- 
mile tea. 

As a cathartic, the most effectual medicine is calo- 
mel, which may be taken in syrup, or mixed with 
crumbs of bread, in a dose of twenty grains. If this 
fail to open the bowels, the dose should be repeated, 
or some other purge administered, such as is most 
agreeable to the patient, within two or three hours af- 
ter the first. Sometimes a third and even a fourth 
dose may be required. The advantages calomel pos- 
sesses over other medicine, are, that it is less offensive 
to the taste, and less bulky, on account of which, and 
of its greater weight, it is less likely to be thrown up 
by vomiting. 

With regard to blood-letting, a remedy in high re- 
pute with Dr. Rush and some others, the most that is 
said of it by a great majority of those practitioners, 
who have treated the disease in ships and in the West 
Indies, is, that where the patient is young and corpu- 
lent, and there is a hard throbbing pulse with violent 
pain in the head and back, it may be advisable to 
draw a small quantity of blood in the first twelve 
hours, but that it is not safe to take any after this pe- 
riod. 

Cold water applied externally is a powerful remedy, 
and sometimes arrests the disease at the onset. When 
therefore a person is attacked, and there is an unnatu- 
ral heat of the skin, cold water should be dashed over 
him from a bucket or pitcher. Where the heat is 
confined to particular parts, the water should be ap- 
plied to these with a sponge or towel. The head will 
probably require this, more than any other part. 

The great object in the cure of this fever is to bring 
the stomach to bear quinine. The only obstacle to 
its administration is the disposition to vomit, which is 
the most fatal symptom of the disease, and the princi- 
pal part of the management consists in the prevention 
or removal of it. The stomach is therefore to be 



26 



YELLOW FEVER. 



treated with the utmost tenderness, and only such 
medicines and drinks given as are very grateful. To 
quiet the stomach, the effervescing mixture 1 is highly 
recommended, and may be given every hour, and to 
each dose may be added 30 drops of laudanum. Or 
instead of these, we may give the chalk mixture in 
table-spoonful doses every half hour, and oftener if 
the stomach rejects it. 

But the most effectual remedy for allaying vomiting 
is a large blister applied over the stomach, and this 
must be laid on early, or as soon as the vomiting has 
commenced. 

No other internal medicine need be recommended, 
for whatever power of retention the stomach may have, 
should be employed upon quinine. 

To take inflammation from the vital parts, blisters 
may be applied not only over the stomach but to the 
legs. To hasten the drawing of them, the parts may 
be previously rubbed w r ith peppered vinegar or other 
strong stimulants. With the same view warm mus- 
tard poultices 2 should be applied to the soles of the 
feet every twelve hours. 

It is very desirable in this fever to excite a mercuri- 
al action, so far at least as to induce a coppery taste, 
and some spitting, but this cannot be done by mercu- 
rial pills or other internal medicines, for reasons above 
stated, viz. the necessity of appropriating the retentive 
power of the stomach to quinine. The object must 
therefore be attained by the use of mercury exter- 
nally. To this end rub a portion of mercurial oint- 
ment of the size of a nutmeg, on the inside of the 
thighs every eight hours, and dress the blisters, if there 
be any drawn, with the same substance. 

So soon as the bowels have been moved and the 
stomach will admit of it, administer quinine, in two 
grain doses every two hours. 

When the stomach becomess perfectly quieted, it will 
afford the patient great relief to procure perspiration 

1 See Appendix. 2 Ibid. 



INFLAMMATORY FEVER. 27 

and sleep, for which purpose a powder, consisting of 
calomel and camphor, of each two grains, and opium 
one grain, to be administered in the evening. 

After the first purging, the bowels must be moved 
every day, but as the stomach will not bear strong 
purgatives in every case, the effect, for the three or 
four first days at least, must be produced by clysters of 
salt water, in connection with the calomel. 

From the first hour of the attack, the patient should 
abstain from solid food, and subsist on sago, gruel, or 
barley-water. His drink may be lemonade, toast- 
water, tamarind- water, orange-juice, &c. 

The same directions are to be observed in regard to 
cleanliness, &c, as are given under the head of Putrid 
Fever. 



OF ACUTE OR INFLAMMATORY FEVER. 

SYMPTOMS. 

It commences with general weariness and anxiety, 
succeeded by dizziness, chills, and pains over the whole 
body, but more particularly in the head and back. 
These symptoms are followed by redness of the face, 
throbbing of the temples, great restlessness, intense 
heat, unquenchable thirst, and nausea. Light is offen- 
sive, the skin is dry and parched, the tongue becomes 
of a scarlet color at the sides, and furred with white in 
the middle ; the pulse is full, hard, and quick ; the 
urine red and scanty, and the body costive. When 
blood is drawn, it exhibits a yellowish or bufTy crust on 
its surface. 

"When the disease is not arrested at the commence- 
ment, it usually goes through its course in about fifteen 
days and terminates critically, either by a perspiration, 
diarrhoea, bleeding at the nose, or the deposite of a 
copious sediment in the urine. In some instances it 
however terminates fatally. High fever with stupor 
and delirium denotes danger, but picking the bed- 



28 INFLAMMATORY FEVER. 

clothes, twitching of the tendons and involuntary evac- 
uations, portend death. 

CAUSES. 

Exposure of the body to sudden alterations of tem- 
per ature, particularly to cold and moisture after being 
heated ; intemperance ; violent exercise. 

This may be distinguished from all other fevers by 
the strength and hardness of the pulse, the whiteness 
of the tongue, and the other symptoms of high fever 
just mentioned. 

TREATMENT. 

In this and all other fevers attended with a hard, 
full, and quick pulse, bleeding is of the first importance, 
and should be employed as early as possible. The 
quantity of blood to be taken, must be in proportion to 
the strength of the patient and violence of the disease. 
From one to two pints may serve for a sailor's con- 
stitution at the first bleeding ; but if after this, his pulse 
should again become hard and frequent, and other 
symptoms of fever return, it will be necessary to repeat 
the operation a second or even a third time, which may 
be done at intervals of twelve, eighteen, or twenty- four 
hours from each other, as symptoms may require. 

The next step after the first bleeding, is to cleanse 
the stomach and bowels, which may be done in the 
following manner : 

Take tartar emetic, five grains ; Epsom salts, two ta- 
ble-spoonsful : mix and dissolve them in a pint of water : 
give a third of this solution every half hour. If the first 
and second dose produce the desired effect, the third 
may be omitted. 

Or, take a common emetic, and in twelve hours after 
a dose of salts or some other active cathartic. During 
the operation of the medicine upon the bowels, the 
patient may take freely of gruel or barley-water. 

To obviate a tendency to costiveness, allay thirst, 
and promote a gentle perspiration, the patient may 



INFLAMMATORY FEVER. 29 

drink freely of toast-water, flaxseed-tea, or barley- 
water, acidulated with cream of tartar. If this mix- 
ture be not sufficiently laxative to produce two or three 
motions of the bowels every twenty-four hours, admin- 
ister the cooling mixture 1 in doses of a table-spoonful 
every three hours. 

Where the bowels are sufficiently loose and require 
no laxative medicine, instead of the foregoing, give the 
following mixture : 

Of antimonial wine and spirits of nitre equal parts : 
give two tea-spoonsful every three hours in toast- 
water. 

For the purpose of allaying inordinate heat of the 
skin of any part, sponge it frequently with cold water. 

If heat and thirst continue very great, the patient 
may take powder of nitre ten grains, every three hours, 
and drink freely of cold water. 

From the first attack, warm poultices, made of 
pounded bread, should be applied to the feet, morning 
and evening. 

If there be a tendency of the disease to any particu- 
lar organ, as the brain, which will be known by the 
presence of great pain of the head or delirium, or to 
the chest, which difficult breathing will indicate, a blis- 
ter should be applied to the neighborhood of the part 
affected. 

Opium is so doubtful a remedy in acute fever, that 
no preparations of it should be prescribed, unless by a 
regular practitioner of medicine. 

Throughout the whole course of the disease the pa- 
tient must abstain from solid food and animal broths, 
supporting nature with gruel and preparations of bar- 
ley, sago, &c. His bed should be lightly covered with 
clothes, and his apartment preserved of a moderate and 
equable temperature. 

1 See cooling mixture in the Appendix. 



30 SCURVY. 



SCURVY. 



SYMPTOMS. 



It commences with unusual weariness, dejection of 
spirits, sluggishness, and offensive breath. The gums 
become soft, livid and swollen, are apt to bleed from 
the slightest cause, and separate from the teeth, leaving 
them loose. About the same time the legs swell, are 
glossy, and soon exhibit foul ulcers ; the same appear- 
ances follow, on other depending parts of the body. 
At first the ulcers resemble black blisters, which spread 
and discharge a dark colored matter. Unless the 
general habit be now corrected by proper diet and 
regimen, these ulcers increase, great emaciation en- 
sues, bleedings occur at the nose and mouth, all the 
evacuations from the body become intolerably fetid, 
and death closes the scene. During the progress of 
the disease, the pulse is generally natural, but towards 
the fatal termination, it becomes weak and unremitting. 
The appetite continues very little impaired, and in some 
cases the patient, even within a few hours of his disso- 
lution, is more eager than ever, in his calls for food. 
His mind remains sound, for the most part, to the last. 
The fatal termination, though gradual in some instan- 
ces, is generally sudden, and is frequently accelerated 
by attempts to move the patient on shore. 

CAUSES, 

Cold, moist air ; the long continued use of salted 
provisions, or other food that is hard of digestion and 
affords little nourishment ; deficiency of vegetables ; 
want of cleanliness ; indolence ; depressing passions 
of the mind ; smoking and chewing great quantities of 
tobacco ; the putrid stench of bilge water. 

TREATMENT. 

This is to be managed by pursuing a course of diet 
and regimen directly opposite to that which induced 



SCURVY. 31 

the disease. Where this can be done, medicine is al- 
most unnecessary. Among the most celebrated and 
infallible remedies, are succulent fruits, of which oran- 
ges, lemons, limes and apples, are the best. Unfor- 
tunately, however, these articles are with difficulty 
preserved on long voyages, and consequently least 
likely to be found when most wanted. Perhaps then 
no article after these is so valuable in long voyages, 
both for its efficacy and imperishable quality, as pota- 
toes, which have moreover the advantage of being 
cheap and easily supplied in almost every port. I 
rarely used any other remedy in a man-of-war, and 
always laid in a stock of them with the hospital stores, 
purposely for the cure of scurvy. Whenever a scor- 
butic patient reports himself unfit for duty, I direct 
him to abstain from all salted food, and to commence 
eating raw potatoes scraped and mixed with vinegar, 
to the quantity of from one to three pounds of the po- 
tatoes a day, according as they may agree with his 
stomach and bowels. The dish is very agreeable, re- 
sembling salad or sliced cabbage. With the same 
materials I dress scorbutic ulcers, and find it as valua- 
ble and as conducive to healthy action as any applica- 
tion I have used. 

It is probable that cabbages, turnips, &c, are equal- 
ly as valuable as potatoes. A preparation of cabbage, 
called krout, is a highly reputed anti-scorbutic, and 
can be kept for years. All vegetable acids, as lime 
juice, tamarinds, cider, pickles, &c, are excellent re- 
medies ; also all saccharine fruits, as pine apples, 
raisins, and figs. When neither vegetables nor lemon 
juice can be procured, take three or four times a day, 
Nitre in doses of ten grains, dissolved in vinegar and 
sweetened. If the vinegar of the ship be exhausted, 
use in place of it the concrete salt of lemon or tartaric 
acid dissolved in water. 

So sudden is the salutary effect of an anti-scorbutic 
diet, that the worst cases of scurvy are very percepti- 
bly relieved by it, in the first twenty-four hours. 



32 SCURVY. 

Such is the general treatment to be adopted in scur- 
vy ; but particular symptoms will require a separate 
management. Pains of the belly must be allayed by 
emollient drinks, as barley water, or sago, and by 
opiates ; difficulty of breathing by the pectoral mix- 
ture ;* diseased gums are to be washed with sal nitre 
so far diluted with water as to be agreeable to the 
taste, or with decoction of bark or quassia, or a weak 
solution of alum ; — the rigidity of the muscles, particu- 
larly the contraction of the hams, and the livid hard- 
ness of the calves of the legs, may be removed by 
warm bathing and emollient poultices ; costiveness 
may be obviated by a solution of cream of tartar. 

It is very remarkable that this disease should at the 
present day be suffered to prevail in merchant ships, 
often to the destruction of half their crews, when pre- 
ventives are so well known and so easily supplied. 
In crossing the Atlantic in a frigate in 1818, we fell in 
with a French ship bound from South America to 
Havre, where this disease had prevailed to such a de- 
gree, that one third of her crew were dead, another 
third at the point of death and the other survivors 
more or less diseased ; all which calamity might have 
been prevented by a supply of potatoes and lemon 
juice of the value of five dollars, or perhaps half that 
value of tartaric acid or the concrete salt of lemon. 

One of these acids should be introduced into every 
medicine chest in large quantities, since it is imperish- 
able by long keeping, and may be carried to sea for 
years, and serve as a last resort when every other acid 
and anti-scorbutic in the ship is exhausted. It has the 
further advantage of being cheap, and less bulky and 
incommodious than other acids of equal value. 

An excellent wash for scorbutic ulcers is made by 
dissolving a large table-spoonful of nitre or saltpetre, 
in half a pint of vinegar, with which cleanse the ulcers 
twice a day. I may further add, that where a crew 

1 See Mixtures in the Appendix. 



JAUNDICE. 33 

is threatened with this disease, it is of the first impor- 
tance to preserve the ship clean and dry, and to keep 
the crew in gentle, and pretty constant exercise. 



JAUNDICE. 

SYMPTOMS. 



Loss of appetite — aversion to exercise — yellow- 
ness of the eyes, and subsequently, of the whole skin. 
The urine is highly colored and tinges the linen yel- 
low ; the stools are white, or of a clay color. The 
patient complains of a bitter taste, nausea and sickness 
at the stomach. Generally there is costiveness, which, 
however, is occasionally interrupted by diarrhoea. 
Frequently a sense of uneasiness and darting pain is 
felt under the short ribs of the right side and at the 
pit of the stomach. 



CAUSES. 



The immediate cause is an obstruction to the passage 
of bile, from the liver into the intestines, on account of 
which, it is thrown back into the circulation and dif- 
fused over the body, imparting to it the yellow color 
above mentioned. This obstruction may proceed. 1. 
From the lodgment of a stone hi the gall-duct. This 
variety of jaundice may be known from the others, 
by occasional acute pains under the short ribs of the 
right side. 2. It may proceed from indurated mucus, 
lodged in the passage of the gall-duct. This variety 
follows a sedentary habit, debility, a long continued 
mercurial course for the venereal disease, and is gen- 
erally unattended by pain. 3. The obstruction may 
proceed from an enlargement of the liver, as in what 
is called the ague-cake, which often succeeds the in- 
termittent or remittent fever, or from that chronic in- 
flammation of the liver wiiich is occasioned by hard 
drinking. In this variety of jaundice, the enlargement 
3 



34 DROPSY. 



of the liver can be felt, which distinguishes it from 
other varieties. There are other kinds of jaundice, 
but they rarely occur among sea-faring people. 



TREATMENT. 



Of the first variety. If pain and inflammation exist 
hi considerable degree, bleed, and bathe the part with 
warm water ; in addition to which, employ the reme- 
dies recommended in the second variety. 

Second variety. Administer an emetic every other 
morning, and if it fail to move the bowels, give on the 
intervening days a mild cathartic, of calomel and ja- 
lap mixed in syrup or other convenient vehicle, and 
repeat the dose every three hours, till it operates. Or, 
Blue pills, three or four, with castor oil, a table-spoon- 
ful. Or, calomel alone, twenty grains. 

A tumbler full of sweet oil, taken in the course of 
an hour after the calomel or the blue pill, is found to 
be a very valuable remedy. 

The warm bath, by its relaxing powers, proves very 
useful in jaundice, and should be employed frequently. 

Exercise of the jolting kind, as running, dancing, 
jumping a rope, is very serviceable. To those who 
reside on shore, riding on horseback is an invaluable 
remedy. 

In the third variety. Where the liver is enlarged, 
mercury should be employed, as recommended under 
the head of chronic affection of the liver. 

The diet should be light and nourishing. 



DROPSY. 

SYMPTOMS. 



General Dropsy commences with a watery swelling 
hi the lower extremities, and first appears towards 
evening in the feet and ankles, afterwards gradually 
ascending and occupying the thighs, trunk, and even 



DROPSY. 35 

head. The swelling is not elastic, but pits, when 
pressed with the fingers, and the pits are slow in fil- 
ling up. When it has become very general, the belly 
swells, the breathing is difficult and accompanied by 
a cough with a watery expectoration. The urine is 
scanty and high colored ; sometimes, however, it is 
of a pale whey color and copious. There is costive- 
ness ; paleness of the skin, and oftentimes insatiable 
thirst. 

CAUSES. 

An hereditary predisposition to the disease ; — cer- 
tain organic diseases, as of the heart and liver, pro- 
ducing an obstruction to the free circulation of the 
blood — preceding disease, as jaundice, diarrhoea, dys- 
entary eruptions, &c. — watery diet. 

A favorable result may be expected, when the cause 
of the disease is easily removed, when the constitu- 
tion is very little impaired, the appetite remains en- 
tire, and the respiration free. Unfavorable, when 
there is the reverse of these, when the heart or liver 
is diseased, — when the emaciation is great, — the thirst 
insatiable — and where there is drowsiness. 

TREATMENT. 

The principal indications in the cure of Dropsy are, 

1. To evacuate the collected fluid. 

2. To prevent its reaccumulation. 
The fluid is evacuated, 

1. By emetics, which may be taken every second 
or third day. 

2. By cathartics, taken on intervening days. 

3. By diuretics, as digitalis, squills, nitre, spirits 
of nitre, in the following manner : 

Take digitalis, one grain, nitre, ten grains, in syrup 
of squills, a tea-spoonful ; every four hours. Or, take 
syrup of squills, and spirits of nitre, of each a tea- 
spoonful ; mix and repeat the dose every four hours. 

4. Mercury ; so exhibited, as to affect the gums and 



36 INDIGESTION. 

produce a spitting. This may be combined with the 
digitalis and squills, in the following manner : 

Take calomel, one grain, digitalis in powder, one 
grain, mixed in syrup of squills a tea-spoonful, and 
repeat the dose every four hours, till the mouth is 
affected, and the swelling subsides. While taking the 
mercury, emetics and cathartics may be omitted. 

5. Sudoriiics ; as Dover's powders, 1 every four 
hours, accompanied by diluting drinks, as toast-wa- 
ter, &c. 

To prevent the reaccumulation of water, the patient 
should subsist on a light, nourishing, high-seasoned 
diet ; — take bark, or quinine, or quassia, and other 
strengthening bitters, — use exercise, friction and cold 
bath. 

Other remedies might be mentioned, as scarifica- 
tions, blisters, bandages, &c, but the above are suffi- 
cient to keep the disease in check, when it appears on 
board ship, till medical advice can be obtained from 
shore. 

Dropsy of the chest, belly, &c, are treated of, un- 
der diseases of those parts. 



OF DYSPEPSIA OR INDIGESTION. 

SYMPTOMS. 

Want of appetite, — rising of food and wind from 
the stomach, — acidity of the stomach, — heart-burn, — 
flushed countenance after a full meal,- — sense of dis- 
tention in the stomach and bowels, — sometimes rum- 
bling and pain, — costiveness, which is now and then 
interrupted by diarrhoea, — dryness and whiteness of 
the tongue in the morning, — paleness of the urine. 
There is general debility, languor and aversion to mo- 
tion, dejection of spirits, disturbed sleep and frightful 
dreams. 

1 See Powders. 



INDIGESTION. 37 



CAUSES. 



Whatever debilitates the system in general or the 
stomach in particular, as opium, — spirituous liquors, 
— hot and strong tea or coffee, — tobacco, — long 
continued vomiting excited by too powerful emetics, or 
long protracted sea-sickness, — poisons, — sedentary 
life, — depressing affections of the mind, — excessive 
evacuations, — diseased liver — excessive venery. 

CURE. 

The first and most important step is to avoid what- 
ever may have tended to give rise to the disease and 
continues to aggravate it ; until this is done, medicines 
will be of very little service. 

The remedies then are, 

1. Emetics. One of the gentle kind should be the 
first medicine given, and if afterwards nausea return, 
accompanied by a rising from the stomach of imper- 
fectly digested food, or acid substances, the emetic 
after four or five days should be repeated. 

2. Purgatives, of the stimulating and gentle kind, 
as powder of rhubarb and magnesia, of each 15 grains, 
which may be taken whenever there is a tendency to 
costiveness. If the bowels be difficult to be moved, 
add to the medicine two or three grains of calomel. 
Or, in place of this, take the common aloectic pills, 
or blue pill. 

3. A nutritious, easily digested diet. In these re- 
spects, animal food is preferable, but in consequence 
of its tendency to induce* costiveness, an occasional 
meal of light vegetable food may be serviceable, and 
a moderate use of sub-acid fruits, as apples, pears, 
&c. The meals should be taken at stated periods, 
and at intervals of three or four hours. The drink 
should be in small quantity, and such as does not be- 
come acid. Watch the effects of the different kinds 
of food and drink, and select that which best agrees 
with the stomach. 



38 FITS. 

4. Exercise. If on shore, walking, riding on horse- 
back, or in a carriage, and these in succession, as are 
most easily borne. Be engaged in some active busi- 
ness or amusement, which will employ the mind. 
Travelling will therefore be very beneficial. 

5. Cold bathing and shower baths, — salt water is 
preferable. Rubbing the surface with salt and brandy 
mixed. 

Lastly. Tonics, particularly vegetable bitters, as 
Peruvian bark, quassia, cascarilla, &c, taken hi the 
following manner : 

Quassia, cascarilla, or Peruvian bark decoction, 1 a 
wine glass in every four hours, or a few minutes be- 
fore eating. After taking it for a few days, its effi- 
cacy will be incr eased by the addition to each dose, 
of ten drops of elixir vitriol. 

Occasional symptoms may require additional re- 
medies. 

Acidity of the stomach and heart-burn can be re- 
moved by chalk or magnesia . Occasional pains of the 
stomach and bowels, which usually depend on windy 
distention, may be relieved by a few drops of pepper- 
mint. Diarrhoea, when it occurs, may be treated by 
small doses of rhubarb and alum combined thus : 

Take rhubarb, five grains, alum two grams every 
three hours, till the diarrhoea is arrested. 



OF EPILEPSY, OR FITS WITH CONVULSIONS. 

SYMPTOMS. 

The patient, if standing, is suddenly thrown to the 
ground in convulsions. During the fit, there are 
strong contractions of the limbs, twistmgs of the body, 
distortions of the countenance, grinding of the teeth 
and clenching of the hands. These continue for a 

1 See Decoctions. 



FITS. 39 

few minutes with such violence, that two or three per- 
sons are not sufficient to hold the patient ; the fit then 
subsides, but shortly after is renewed. After three or 
four returns, they cease altogether and leave the pa- 
tient senseless, generally in a profound sleep. Com- 
monly the patient has no warning of the fit, yet some- 
times it is preceded by pain in the head, unquiet sleep, 
noise in the ears ; in some instances, by a sensation 
of cold ah* commencing in one of the limbs, and 
gradually creeping upwards till it reaches the head, 
when the patient falls hi a fit. In those who are much 
subject to fits, they sometimes occur hi sleep. 

CAUSES. 

Irritation of body or violent excitement of mind. 
But these causes rarely take effect, unless there exist 
a strong predisposition to the disease, either heredi- 
tary, or from debility, with great mobility either natu- 
ral or acquired. Perhaps no class of people of equal- 
ly hardy constitutions are so subject to this disease as 
sailors. 

TREATMENT. 

The only thing to be attempted during the fit, is to 
protect the patient from bruises, which his strong con- 
vulsions are apt to occasion. Some physicians are in- 
clined to bleed, but this is difficult to do on board 
ship, and excepting in the robust and plethoric is not 
advisable hi any situation. 

When restored to his senses, attend to the exciting 
cause of the fit, and remove or avoid it. In almost 
all cases, it is advisable after a fit, to move the pa- 
tient's bowels, with a draught of salt-water, or some 
other purgative. He should avoid a costive habit, and 
abstain from ardent spirits, with all other strong stim- 
ulants. 

When the patient is warned of an attack, it may in 
some instances be averted by vomiting or purging. 

Where the fits recur very often, I have always been 
able to suspend them by exciting a mercurial action. 



40 APOPLEXY. 

In cases where the fit commences with a sensation 
of cold air, creeping along one of the limbs towards 
the head, apply a string around the limb, and direct 
the patient to draw it tight, when the sensation is first 
felt, by twisting a stick, which is to be worn in the 
string ready for the purpose. I have commonly used 
a field tourniquet, and have seen a patient avert fits 
for months, who, without this apparatus, was attacked 
by them three or four times a week. The pressure 
need not be continued more than a minute. The ap- 
paratus may be so applied, as to occasion no impedi- 
ment to exercise or labor. Those who are subject to 
this disease should never be sent aloft, nor indeed on 
shipboard. 



OF APOPLEXY. 

SYMPTOMS. 



Total suspension of the powers of sense and mo- 
tion, accompanied by snoring — foaming at the mouth, 
and grinding of the teeth — the eyes are prominent and 
fixed, and the pupils dilated — the pulse is very little 
disordered. 

Persons, from fifty to sixty years of age, are most 
liable to it, particularly those who have short necks, 
with large heads, and who indulge in the luxuries of 
the table. 

The fit is usually induced by some violent excite- 
ment of body or mind, long stooping, derangement of 
the stomach, overloading it with pastry, fumes of poi- 
sonous substances, foul airs, &c. 

TREATMENT. 

When the patient is seized, take from him a pint and 
a half, or two pints of blood. The difficulty of start- 
ing blood in a fit of apoplexy, may make it necessary 
to open veins in both arms, and both feet, at the same 



LOCKED-JAW. 41 

time. The head is to be shaved, and bathed with cold 
water and vinegar, the feet and legs bathed in warm 
water, and a drastic purge administered, of calomel, 
forty grains ; or calomel thirty, jalap twenty, mixed. 
If this course fail to render the patient sensible, a 
large blister must be applied to the head and the bleed- 
ing repeated. 

The rare occurrence of this disease among sailors, 
renders it unnecessary to say more of it here. 



OF TETANUS, OR LOCKED-JAW. 

SYMPTOMS. 

It commences with a sense of stiffness in the back 
part of the neck, rendering the motions of the head 
difficult and painful. This is soon succeeded by diffi- 
culty of swallowing ; pain, often violent, about the 
breast bone and thence shooting to the back ; rigidity 
of the lower jaw, which increasing, the teeth become 
so closely set together, as not to admit of the smallest 
opening. If the disease proceed further, a greater 
number of muscles become affected, and the body is 
forcibly bent either backwards, or forwards. At length 
the trunk, limbs, and countenance are distorted to a 
most painful and shocking degree. A remission of 
these symptoms occasionally takes place every ten or 
fifteen minutes, but they are renewed with aggravated 
force by the slightest causes, even the least motion 
of the patient, or the touch of an attendant. Finally, 
a general convulsion puts a period to a most miserable 
state of existence. 

The duration of lock-jaw is various. 

CAUSES. 

The disease is very common in hot climates, and is 
most frequent when a scorching sun is succeeded by a 
heavy rain or dew. 



42 SMALL-POX. 

But besides exposure to sudden changes of temper- 
ature, it is often caused by a wound of a nerve or ten- 
don, or by a fractured bone. 

TREATMENT. 

Give opium in large quantities, as four or five grains 
every horn-, or three drachms of laudanum, every half 
hour. When the patient can no longer swallow, inject 
laudanum, a table-spoonful in warm water, every hour, 
and direct it to be retained as long as possible. 

With the first dose of opium give twenty grains of 
calomel, and follow it every six hours by a dose of five 
grains, till the mouth is affected. 

Use warm and cold bathing in succession. If the 
disease proceed from a wound, enlarge it pretty exten- 
sively, and pom* into it hot spirits of turpentine, or 
burn the wound with an iron, brought to a white heat. 



SMALL-POX. 

SYMPTOMS. 



It begins with pain in the head and back, sickness 
at the stomach, and chills. In this stage, it may be 
mistaken for rheumatism or pleurisy. About the fourth 
or fifth day, it breaks out in small pustules upon the 
face, breast, and neck, and on the ninth, tenth, or 
eleventh day, the pustules are at their full size, when 
they begin to dry and scale off : this is the milder stage 
or distinct small-pox. In the more aggravated kind, 
called the confluent, the pustules are more thick and 
red, and running into each other, spread over the whole 
body. They are not at their full size till the fifteenth 
or sixteenth day. The eyes are completely closed, 
the fever runs high, and the danger is very great. 



TREATMENT. 



When the disease breaks out in a vessel, 

1. Keep the patient as cool as possible, with light 



MEASLES. 43 

covering to the body, and if the weather be hot, bathe 
the skin frequently with cold water. 

2. Preserve a loose state of the bowels, by admin- 
istering a dose of salts, or cream of tartar, or some 
other mild purgative, every other day. 

3. Abstain from animal food, spirituous liquors, and 
all stimulating or acrid substances, subsisting on rice 
and molasses, barley, flour, gruel, &c, and sweet or 
subacid fruits. 

This course is to be pursued as long as there is much 
fever, or until the pustules are filled and begin to turn 
yellow ; the patient may then return to a nutritious 
diet, and take tonics, such as decoction of bark or 
quassia, and elixir vitriol. 



MEASLES. 

SYMPTOMS. 



Slight fever ; cough ; hoarseness ; difficult breath- 
ing ; sneezing ; sense of weight in the head ; sickness 
at the stomach ; dulness of the eyes ; drowsiness ; 
itching of the face. On the fourth day, small red 
points appear, first on the face and subsequently on 
the lower parts of the body. On the fifth or sixth day, 
the lively red is changed to a brown, and in a day or 
two, the eruption entirely disappear 

TREATMENT. 

Abstain from animal food and spirituous liquors ; 
adhere strictly to a low, unseasoned diet ; keep in a 
moderately cool atmosphere, and preserve a loose state 
of the bowels by taking castor oil, or cream of tartar, 
or sulphur and cream of tartar mixed, or small doses 
of Epsom, or Rochelles. 



44 INFLAMMATION OF THE BRAIN. 



OF INFLAMMATION OF THE BRAIN, OR BRAIN 
FEVER. 

SYMPTOMS. 

Very severe pain in the head ; extreme sensibility 
to light and sound ; wild expression of countenance ; 
staring of the eyes ; peculiarly hard and rapid pulse ; 
restlessness ; parched tongue ; turgid and flushed face ; 
a rapid flow of ideas. 

CAUSES. 

Exposure to excessive heat, or to sudden changes of 
temperature ; coup de soleil or stroke of the sun, from 
subjecting the head uncovered to its vertical rays ; vio- 
lent exercise ; the abuse of spirituous liquors ; exter- 
nal violence, &c. 

It may be distinguished from madness, by the symp- 
toms of fever and the violent headache which attend 
it ; from the deliriums of inflammatory and typhus 
fevers, by reference to its causes, and by its sudden 
accession after exposure to them. 

Active inflammation of the brain usually terminates 
fatally, and within four days. In a few instances, it 
ends favorably, in inflammation of some other part, or 
by some evacuation. 

TREATMENT. 

Depletion is the principal remedy. From one to 
two pints of blood should be taken at the first bleeding, 
and this operation repeated at intervals of a few hours, 
till the delirium is overcome. 

Cathartics, of the active kind, are to be employed, 
as the following : 

Calomel twenty grains, or calomel and jalap, salts 
two ounces. 

After the bowels have been freely moved, give a so- 
lution of tartar emetic, one grain every four hours. 

The heat of the head must be allayed by cold water 



DISEASES OF THE HEAD. 45 

applied with towels, and the neck may be blistered. 
Blisters should also be applied to the ankles. The 
feet may be bathed in warm water, and poulticed with 
mustard-seed, spread over Indian or rye meal poul- 
tices. 

The patient must subsist on toast or barley water, 
and gruel. 



CATARRH, OR COLD. 

SYMPTOMS. 

Inflammation of the internal surface of the nose and 
throat, with a sense of fulness, and an increased dis- 
charge from the nose of an irritating watery fluid. 
There is usually a sense of weight and pain in the 
head, oppression of the chest, watery inflamed eyes, 
soreness of the throat, and sometimes cough ; cold 
shiverings succeeded by transient flashes of heat. 

CAUSES. 

Exposure of the body to sudden changes of tem- 
perature, wearing damp clothes, &c. Sometimes it is 
epidemic, and is then called influenza. 

TREATMENT. 

An emetic is a very efficacious remedy. If the pa- 
tient be averse to this, administer a dose of salts, or 
some other cooling purgative. 

Preserve an uniform temperature of the body, nei- 
ther very warm nor cold ; drink freely of warm flax- 
seed tea, barley or toast- water, with cream of tartar 
dissolved in it. 

Bathe the feet in warm water on going to bed, and 
avoid exposure of the body to cold the day following. 
Keep the feet continually warm. 

To allay coughing and irritation of the throat, drink 
4 



46 DISEASES OF THE HEAD. 

spermaceti dissolved in warm tea, or take it in sub- 
stance, or, take liquorice. 

When the cough is very troublesome, and prevents 
sleep, take pectoral mixture, 1 two tea-spoonsful on 
going to bed, in a large draught of barley-water, or 
flax-seed tea ; or, take Dover's powder ten grains ; 
or the cooling mixture a table spoonful every three 
hours, adding to the last dose in the evening (which is 
to be taken on going to bed,) fifteen drops of lauda- 
num. 



OPHTHALMY, OR INFLAMMATION OF THE EYE. 

There are two kinds. — 1. A disease of the eyeball. 
2. Of the eye-lid. 

SYMPTOMS. 

The former commences with itching, burning, and 
a sensation, as if sand or sticks were lodged under the 
eye-lid. The white of the eye turns red, and swells, 
and there is an increased sensibility of the organ to 
light and motion. When the inflammation runs very 
high, a slight fever attends it. 

TREATMENT. 

When occasioned by the presence of irritating par- 
ticles, these must be immediately removed. 

Unless the ophthalmy be very violent, general bleed- 
ing is hardly ever necessary. In all severe cases, how- 
ever, if leeches can be obtained, apply three or four 
on the temple, near the eye, every morning. 

Take an active purgative of calomel and jalap every 
third or fourth day, till the inflammation abates ; or 
salts, an ounce and a half. 

To take off the heat of the eye by evaporation, ap- 

1 See Mixtures in the Appendix. 



DISEASES OF THE HEAD. 47 

ply frequently to it a soft linen rag, dipped in water, 
at first blood warm, but afterwards cold. 

After two or three days, if the inflammation con- 
tinue active, apply in the same manner the following : 

White vitriol and sugar of lead, each two grains, 
dissolved in a gill of pure water, or rainwater. 

If the itching and pain be great, add to the mixture 
laudanum, two drachms. 

If the inflammation be not reduced within three or 
four days from the attack, apply blisters behind the 
ears. 

From the first attack, abstain from stimulating food 
and drinks, and keep the eye lightly covered. 

In slight cases of ophthalmy, it may perhaps be suf- 
ficient to take some mild purgative, and use the above 
applications for the eye. 

In the other species of ophthalmy, there is usually 
a small ulcer at the roots of the eye-lashes ; this may 
be touched with a little warmed citron ointment, or 
with alum- water, by means of a hair pencil. 



BLEEDING- AT THE NOSE. 

TREATMENT. 

During the bleeding, sit in a cool air, with the head 
raised, and wet the neck frequently, with cold water. 
If this fail to stop the bleeding, sit on cold wet clothes, 
with the skin in contact with them, or in cold water. 

If the bleeding still continue, apply astringents to 
the inside of the nostrils, as the following : — 

Powder of alum, a tea-spoonful dissolved in one 
gill of water. A rag may be dipped in it, and intro- 
duced into the nose. Or, apply in the same manner, 
white vitriol, one drachm, dissolved in a gill of water. 

Persons subject to this complaint should avoid a 
costive habit, and move the bowels frequently, by a 
draught of sea- water or a dose of salts. If this be 



48 DISEASES OF THE HEAD. 

insufficient to prevent its return, let blood from the 
arm. Abstain from stimulating food and drinks, and 
avoid every occasional cause, as violent exercise, tight 
neck-cloth, stooping postures, and external heat. 



HEADACHE. 



The most usual causes are indigestion, foul, or over 
loaded stomach, long exposure to the sun, rheumatism, 
intemperance, too great a determination of blood to 
the head. Generally, however, it is only a symptom 
of other diseases, as of fever, catarrh, dropsy, &c. 

TREATMENT. 

"Where a headache is symptomatic of some other 
disease, it will readily cease on removal thereof, as in 
the case of fever. 

When a foul stomach or the presence of indigesti- 
ble substances is apprehended, take a gentle emetic, 
and if costiveness exist, remove it by some mild laxa- 
tive. 

If too great a determination of blood to the head be 
suspected, bleed, and subsist on a low diet. 

If the headache be rheumatic, apply blisters to the 
extremities, or to the back of the neck, and move the 
bowels by common cathartics. 

In cases of slight headache, it may be sufficient to 
bathe the feet in warm water, and wet the head with 
ether or spirits. 



TOOTHACHE. 



TREATMENT. 



If the tooth be much decayed, extraction is the only 
sine remedy. When this is impracticable, the pain 



DISEASES OF THE THROAT. 49 

may sometimes be relieved, by applying to it pills, 
made of opium and camphire, equal parts ; and oil or 
essence of peppermint sufficient to moisten the mass. 
Or, apply elixir paregoric or laudanum on cotton. 

If the pain proceed from a cold, or be a rheumatic 
affection, scarify the gum with a lancet or sharp pen- 
knife, and apply a blister behind the ear. 



EARACHE. 



CAUSES. 

Whatever induces other inflammations ; more fre- 
quently, exposure of the ear to a current of air, or to 
a cold damp wind. 

TREATMENT. 

Syringe the ear with warm water, and fill it with 
laudanum or sweet oil, covering the part with flannel. 
If this fail to relieve $ apply a blister behind the ear, 
take a cathartic, and steam the ear, by holding it to 
the mouth of a jug filled with hot water. When the 
pain, instead of abating, increases for three or four 
days, the formation of matter may be expected and 
should be encouraged, by the frequent application of 
warm poultices. 

When matter begins to be discharged, syringe the 
ear frequently, with warm water containing a little 
soap. 



DISEASES OF THE THROAT. 
INFLAMMATION OF THE THROAT, OR QUINSY. 

SYMPTOMS. 

The throat internally, is red and swollen. There is 
generally some fever, a constant flow of viscid spittle, 
4* 



50 DISEASES OF THE THROAT. 

and pain in swallowing. "When the inflammation is 
not subdued within five or six days from the first at- 
tack, a tumor containing matter will appear in the 
throat, and break. 

CAUSES. 

The usual causes of inflammation ; particularly sud- 
den cold ; occasioned by omitting some part of the 
covering usually worn about the neck ; by sleeping in 
a damp bed ; or wearing wet clothes. 

TREATMENT. 

As it is important to prevent the formation of matter 
in the throat, the treatment should be active, and early 
in the disease. 

If the symptoms be severe, bleed freely and admin- 
ister a dose of salts. Bathe the feet in warm sea wa- 
ter. Wear flannel or a stocking around the neck ; or 
mash roasted or boiled potatoes, and apply them in a 
stocking, as warm as the patient can bear. Gargle 
the throat every ten minutes, with a mixture of warm 
vinegar and water sweetened ; or, with warm vinegar 
containing table-salt dissolved. 

If this treatment fail to reduce the inflammation 
within the first forty-eight hours, the bleeding and 
purging are to be repeated, and a blister applied to 
the throat. 

Abstain from solid food and stimulants. 

If matter form, the difficulty of swallowing will be 
increased, and the patient in some danger of suffoca- 
tion. In this case, the suppuration must be hastened 
by inhaling the steam of warm water, from the nose 
of a tea-pot, and the application of large poultices 
around the throat. 

Those who have had this disease once, are more lia- 
ble to subsequent attacks. 

In slight cases of sore throat, it may be sufficient to 
wear flannel, or hot roasted potatoes around the 
throat, and preserve an open state of the bowels. 



DISEASES OF THE THROAT. 51 



MUMPS. 

This commences with slight fever, followed in two 
or three days, by a swelling under the ear. In severe 
cases, the testicles are affected, and sometimes the 
brain. 

It usually requires nothing more than the applica- 
tion of flannel to the part primarily affected, a gentle 
laxative, and a low diet. When the case is very se- 
vere, or when the testicles and head are affected, use 
bleeding, purging, &c. 



CROUP. 



SYMPTOMS. 



This is an inflammation of the trachea or wind-pipe, 
and is mostly confined to children. There is hoarse- 
ness, particularly in coughing, the sound of which has 
been compared to the barking of a young dog, or of 
air passing through a brazen tube. There is difficult 
breathing and dry cough, which in severe cases in- 
crease, till the patient is worn out, or till suffocation 
takes place. 

When it occurs on board ship, administer an em- 
etic, employ the general treatment recommended in 
quinsy, and apply a blister to the throat. The emetic 
consisting of wine of antimony and squills, mixed ; a 
tablespoonful may be repeated often. 



CHRONIC BRONCHITIS AND LARYNGITIS. 

This disease seldom occurs among sailors ; but as 
those who are affected with it on shore find great 
benefit in change of residence from a cold to a warm 



52 DISEASES OF THE THROAT. 

climate during the winter, and are much in the habit 
of taking passage in ships for Cuba and the other 
West India islands, and for the south of Europe, some 
notice of the disease, from one who has seen many 
cases of it, may be acceptable to such passengers 
while on board ship. 

This disease is more prevalent among clergymen, 
lawyers, and other public speakers, than among labor- 
ing classes. It is called Laryngitis, when the pain, 
soreness, and tickling exist in the top of the windpipe, 
where it is most prominent, and the disease extends 
upward, so as to be visible in the throat. It is called 
Bronchitis when it extends downward to the sternum, 
and along underneath it, producing soreness and pain. 
Both forms of the disease are attended with coughing, 
but in Laryngitis, the tickling sensation which causes 
it, is seated in the top of the throat ; in Bronchitis, the 
irritation seems lower down, even in the lungs ; the 
cough is severe, and causes the disease to be con- 
founded with consumption, from which it may how- 
ever be distinguished by the healthy natural sound of 
the chest on percussion, and by the absence of those 
respiratory sounds known to physicians as signs of 
consumption ; by the patient's ability to lay on either 
side, and by the absence of copious expectoration of 
pus, especially in the early stages. 

There is, however, both in Bronchitis and Laryngi- 
tis, expectoration of specks of pus mixed with much 
glairy mucus, and occasionally there will be streaks 
of blood. 

These two diseases sometimes succeed to severe and 
long-protracted cold, but more commonly they come 
on spontaneously, and oftentimes so insidiously that 
the existence of the clergyman's sore throat is often 
not suspected until it has made great inroads upon the 
mucous surface of the throat in the form of small ex- 
cavations, sometimes as large as a split pea, and the 
whole surface appears rough, as if pitted with small 
pox, some specks being very high- colored, and otherr 



DISEASES OF THE THROAT. 53 

presenting a foul whitish appearance. Its prevalence 
among ministers more than any others, is not satisfac- 
torily accounted for ; and perhaps it is, after all, more 
apparent than real — for, with them, it is always soon- 
er known, and more generally from its disabling them 
for their public duties. It is doubted which sex 
suffers most from it, but the age most affected is be- 
tween twenty and forty. Although the surface of the 
air-pipes shows more of the affection, yet it is believed 
that muscular debility of the vocal organs is often 
present. 

The affection that appears on inspection of the 
throat, is probably but a small part of what actually 
exists ; it extends downwards towards the lungs, and 
the chief source of danger is, that it will run into con- 
sumption, and some eminent writers even maintain, 
that tubercles in the lungs coexist with the throat 
affection, but this is doubtful. Another mode of fatal 
termination is disorganization of the throat itself, either 
the cartilages composing the larynx or prominent part, 
or of the pipes that extend into the lungs. 

TREATMENT. 

Rest of the vocal organs is indispensable ; leeches 
over the part most affected ; a blister applied to the 
top of the sternum or breast bone, and repeated as 
often as it heals, which is preferable to a continued 
one. Inhalation of the steam from simmering tar, 
through a tube attached to the nose of a teapot half 
filled with tar, which may stand over a blazer ; or the 
tar may boil in like manner in a plate, and the patient 
inhale the steam diffused through his apartment. The 
vapors of iodine and of chlorine are often used with 
advantage, to the former may be added tincture of 
conium, as directed in several medical works. 

Topical applications in solution may be applied 
with a swab, or, what is better, by sewing a brush of 
lint to the end of the finger of a glove, which is then 
drawn on the index finger of the right hand ; the pa- 



54 DISEASES OF THE THROAT. 

tient is made to gargle with warm water, and the lint 
being dipt in the solution, can be readily applied to 
the larynx. The best solution to apply is nitrate of 
silver, two grains to an ounce of water, which may be 
repeated once a day, one in alternate weeks. 

Among the gargles that I have tried with most suc- 
cess, is the following : — R. Tr. myrrh and ether, of 
each half an ounce ; honey, one ounce ; and strong 
sage tea, four ounces. 

The internal use of tar water, to the extent of from 
one to two pints a day, is serviceable. The daily 
evaporation of alcohol over the throat is by some 
highly recommended. 

A sea voyage to a warm climate during the winter, 
is among the best remedies. 



PUTRID SORE THROAT, OR SCARLET FEVER. 

SYMPTOMS. 

It commences with cold shiverings — sickness and 
vomiting — heat and restlessness — great debility — 
flushed face — hoarseness and sore throat. Upon in- 
spection, the internal surface appears of a fiery red 
color, which soon becomes darker and is interspersed 
with specks, of some shade between a light ash and 
dark brown. There is considerable fever, which in- 
creases every evening — a small and irregular pulse, 
and oftentimes diarrhoea. About the second or third 
day, large scarlet colored patches or stains appear up- 
on the neck and face, and afterwards over the whole 
body. After continuing about four days, they depart 
with a scaling of the sldn. In bad cases, the ulcers 
in the throat corrode deeper and deeper, debility in- 
creases to complete exhaustion, and the parts mortify. 
The patient expires usually before the seventh, often 
as early as the third or fourth day. 

This disease is epidemic, often spreading through a 



DISEASES OF THE THROAT. 55 

whole village. Long exposure to a humid atmos- 
phere and a debilitated habit, predispose to an attack. 
This kind of sore throat may be distinguished from 
quinsy, or common sore throat, by the eruption or 
specks above mentioned, by the weak fluttering pulse, 
general debility, and by the scarlet spots that appear 
on the skin. Each of these diseases however, often 
partakes so much of the character of the other, that 
it is not always easy to distinguish them. It may be 
known from croup, by the absence of a croaking 
hoarseness, and by the presence of visible inflamma- 
tion and specks above mentioned. The putrid sore 
throat prevails mostly among children, and rarely ap- 
pears on board ship. 

TREATMENT. 

In the treatment of putrid sore throat, bleeding and 
active purging would be likely to increase the debility, 
which is already very great. The stomach and bowels 
must however be cleansed; for which purpose, take 
Ipecac : twenty-five grains, adding to it five grains of 
calomel, or some other purgative in small quantity. 

The principal indications of cure then are, 

1. To counteract the putrid tendency that prevails. 

2. To wash off frequently the acrid matter from 
the throat, and, lastly, to obviate debility. 

To correct the putrid tendency, Peruvian bark, 
quinine, mineral acids, and Cayenne pepper, are 
among the most valuable remedies. They may be 
taken in the following manner : 

Take powder of bark, two table-spoonfuls, Cayenne 
pepper, one table-spoonful ; to which add three gills 
of boiling water, and after boiling it in a covered ves- 
sel ten minutes, add one gill of vinegar. Administer 
two table-spoonfuls every two hours. Or, take de- 
coction of bark, or of quassia two table-spoonfuls, 
with ten drops of elixir vitrol, mixed, every two hours. 

To cleanse the throat, use gargles of salt dissolved 
in vinegar ; — or elixir vitriol, a tea-spoonful to half a 



56 DISEASES OF THE CHEST. 

pint of warm water, sweetened, every ten minutes. 
Inhale the steam of warm vinegar and water, from the 
nose of a teapot. Breathe the air, made by burning 
nitre, thus : 

Close the patient's room, and upon a chafing dish of 
coals, throw powder of nitre half an ounce ; which 
will fill the room with a thick white cloud, that will 
last for some time. This process may be frequently 
repeated in the course of the day. 

If any particular symptom of an alarming nature 
arise during the progress of the disease, as diarrhoea, 
bleeding, &c, it must be checked immediately. For 
diarrhoea administer opium and lime water, or, pow- 
der of alum three grains. Bleeding is also to be 
treated with astringents, both locally and generally, as 
directed under the heads of different kinds of bleedings. 



PLEURISY. 



Pleurisy, pneumonia, peripneumonia, and lu?ig- fever, 
are names given to inflammations of the lungs them- 
selves, or of the membrane that covers them and lines 
the cavity of the chest. It is however improbable that 
either the lungs or this membrane are ever inflamed to 
a great degree separately, the disease of one, being 
generally more or less extended to the other. On this 
account, and because the symptoms and treatment of 
the two diseases are nearly the same, they are both 
included here under the head of pleurisy. I may re- 
mark, however, that painful breathing belongs more 
to pleurisy than to peripneumonia, whilst the latter is, of 
the two, more likely to prove fatal. 



SYMPTOMS. 



It commonly commences with the usual symptoms 
of fever, accompanied or succeeded by a sense of 
weight, and afterwards pain in the chest. This begins 



DISEASES OF THE CHEST. 57 

in one side, ordinarily about the sixth or seventh rib, 
from which it shoots towards the breast-bone and 
shoulder-blade. The breathing is short and difficult, 
and the pain is increased on drawing in the breath. 
There is constant inclination to cough, but every effort 
is interrupted by the pain it occasions, in consequence 
of which, viscid mucus collects in the air-passages, 
and causes a sort of wheezing called rattles. 

The disease begins to subside from the fourth to the 
seventh day : if not so soon as the latter period, the 
case may be considered dangerous. The abatement 
of the inflammation is marked by an amelioration of 
all the distressing symptoms, and a copious expecto- 
ration, 

TREATMENT. 

The great remedies in pleurisy and penpneumony, 
are bleeding, blistering and purging. In severe cases 
its rapid course and fatal tendency require that these 
should be employed with promptness and energy. 
Blood is to be drawn from a large orifice in the arm, 
till the patient is relieved of his pain and difficult 
breathing, provided the quantity for this be short of 
two pints. If the first bleeding fail to relieve, or if 
after relieving, the pain and difficult breathing return, 
the operation should, after twelve hours, be repeated. 

Move the bowels as early as convenient, by a mild 
laxative, as salts, one ounce. 

Immediately after the first bleeding, apply a large 
blister upon the side, near the seat of the pain. 

Bathe the feet in warm sea- water, and apply warm 
poultices to them. 

Take very freely of warm barley-water, or flaxseed 
tea, made agreeable with sugar. 

If the above fail to relieve the pain and other symp- 
toms, within the first thirty-six hours, move the bowels 
again by the cooling mixture, taking a wine-glass full 
every hour, till it operates. Another blister may be 
applied to the chest, and the bleeding repeated even a 



58 DISEASES OF THE CHEST. 

third time. As soon as the pain is relieved and expec- 
toration has commenced, give Dover's powders, ten 
grains, or pectoral mixture, a table spoonful, every 
three hours, and continue the warm drinks. 

Preserve a constant warmth of the skin by keeping 
in bed, and a uniform temperature of the apartment. 
During convalescence, the patient may subsist on a 
generous diet, and use wine. 



CONSUMPTION. 



The great length of time necessary for consumption 
to develop itself and become confirmed, might lead 
one to suppose that it can hardly occur on shipboard 
during a single voyage, and consequently, that medical 
advice would be unnecessary, in a book like this, 
which is merely intended to afford advice to sailors 
while at sea, and out of the reach of physicians. 
Consumption, however, has time to commence, in a 
single voyage, and when it is considered, that it is in 
the first stage only, that advice and medicine are sure 
to prove beneficial, the necessity of making the sailor 
acquainted with the nature of the disease will be ad- 
mitted. 

But another reason for introducing some account of 
consumption is, that persons laboring under the ad- 
vanced stages of it, are not unfrequently sent to sea, 
with the hope of deriving benefit from sailing, or from 
change of climate, and to such, while on shipboard, 
the following sketch may be acceptable. 

SYMPTOMS. 

The tubercular consumption, which is by far the 
most common kind, may be divided into three stages 
or periods. In the first stage, the disease is slowly 
developed, ordinarily without being noticed. In this 
period it is very important to recognize it, but the phy- 



DISEASES OF THE CHEST. 59 

sician is not often consulted so early. The first symp- 
toms are a short, dry cough, the breathings being more 
easily hurried by bodily motion, the patient's becom- 
ing languid, indolent and dyspeptic, and his gradually 
losing strength ; at length, from some fresh exciting 
cause, the cough becomes more considerable, and is 
particularly troublesome during the night ; breathing 
is more anxious ; sense of straitness and oppression 
across the chest is experienced ; an expectoration 
takes place, at first of frothy mucus, which afterwards 
becomes copious, viscid and opaque. These symp- 
toms may be gradually progressing for months. The 
emaciation and weakness go on increasing ; a pain 
arises in some part of the breast, at first unsettled, but 
afterwards fixes in one or both sides, is increased by 
coughing, and sometimes becomes so acute as to pre- 
vent the patient's lying upon the affected side. 

The disease now passes to the second period, in 
which it is easily recognized. Purulent matter, resem- 
bling that made by a common ulcer, is coughed up. 
To distinguish whether it be such, or only mucus, mix 
some that is raised in the morning, in salt water ; if 
mucus or common phlegm, it swims and holds to- 
gether ; if pus, it sinks, and on stirring, separates into 
particles ; purulent matter is also opaque, has a green- 
ish color, and is sweet to the patient's taste. Hectic 
fever takes place, known by a flushing of the face, by 
a hard, quick and frequent pulse, beating more than 
one hundred in a minute, and by high colored urine. 
The hectic has an exacerbation or increase twice in 
the day ; the first time about noon, which is inconsid- 
erable, and soon suffers a remission ; the other in the 
evening, which gradually increases until after midnight. 
Each of these fever-fits is preceded by chills, and ter- 
minates in profuse perspiration. In the morning, the 
patient is better, and thinks himself well. The cough 
and difficult breathing now go on increasing, and 
oftentimes there is a hoarseness or shrillness of the 
voice. After this stage is well established, by the ap- 



60 DISEASES OF THE CHEST. 

pearance of the above symptoms, the patient may die 
in six or eight weeks. He is however able to go 
about, and when the expectoration of pus is first es- 
tablished, the appetite, that was lost in the first stage 
of the complaint, returns. During the fever fits, a 
circumscribed redness appears on each cheek, but at 
other times, the face is pale, and countenance dejected. 

The third period is that of general exhaustion, the 
countenance is peculiar, and easily recognized by all. 
The cough becomes more hard and difficult, especially 
in the morning, when it often produces vomiting ; 
emaciation is extreme ; diarrhoea comes on, and gene- 
rally alternates with melting sweats ; the legs swell ; 
little ulcers appear in the throat ; still the appetite 
often remains entire, and the patient flatters himself 
with hopes of speedy recovery, and is forming plans 
of interest or amusement, when death puts a period to 
his existence. 

Females are more liable to the disease than males, 
partly from their more delicate organization, and con- 
sequent inability to withstand vicissitudes of tempera- 
ture, partly from errors in dress, particularly of the 
chest, by compressing it, and of the feet, by imprudent 
exposure. 

The age most susceptible, is between twenty and 
forty. It rarely proves fatal before the age of fifteen, 
and the general average of tables show the greatest 
number of deaths happen between twenty and thirty, 
the next in proportion, between thirty and forty, and 
then between forty and fifty. 

When the disease first appears, there is always con- 
siderable hope, that if properly treated, it may be stayed 
in its progress ; and if this can be done once, and the 
patient in some measure improved in health, a repeti- 
tion of the same course of treatment may again suc- 
ceed from time to time, until the patient has turned 
the age of thirty, when the danger will, ever after, be 
constantly lessening. 

Spitting of blood sometimes induces the disease, or 



DISEASES OF THE CHEST. 61 

is the first symptom noticed. In other cases it occurs 
in the course of the disease, and sometimes termi- 
nates it. 

CAUSES. 

Particular constitutions are more liable to consump- 
tion than others, as where an hereditary predisposition 
exists, or particular formation of body, marked by 
long neck, prominent shoulders and narrow chest. 
The remote causes are, constitutional irritability of the 
lungs ; a scrofulous habit, indicated by a clear skin, 
fair hair, delicate rosy complexion, large veins, thick 
upper lip, and weak voice. In such subjects tuber- 
cles form in the substance of the lungs resembling in 
color and consistence crumbs of hard cheese, from the 
size of a pin's head, to that of a large pea. These 
tubercles may remain dormant for many years, and 
probably even to old age, but they are liable at any 
time to undergo changes that will induce consumption 
either by softening into a matter resembling pus, or 
by exciting inflammation in the surrounding sub- 
stance, and in either case causing ulcers that are diffi- 
cult to heal, and may extend and involve a large por- 
tion of lung, and finally prove fatal. In some rare 
instances, they heal, and present a fight-colored puck- 
ered scar. Many of these tubercles may ulcerate to- 
gether, and form one large cavity. The more imme- 
diate or exciting causes are preceding disease — as 
spitting of blood, pneumonia, catarrh, venereal disease, 
fistula — depressing passions of the mind — intemper- 
ance — profuse evacuations, as diarrhoea ; or a large 
ulcer. 

TREATMENT. 

In the first stage, and before hectic fever begins, or 
much emaciation appears, and before the lungs are 
much affected, which a physician can ascertain by ex- 
amining the chest, there is good reason to hope that 
5* 



62 DISEASES OF THE CHEST. 

the disease may be removed, or may at least have its 
progress stayed. 

The treatment may require to be modified at 
the outset, according to the prevailing symptoms — 
bleeding at the lungs, or the long existence of catarrh, 
or a recent lung fever, may require the use of some of 
the remedies mentioned under those heads. 

I will mention a few of the most approved remedies 
in the early stage of consumption. 

1. Sailing and change of climate ; these are so im- 
portant that I have appropriated a separate chapter to 
their consideration. 

2. Exercise in the open air, and travelling on horse- 
back, and in open vehicles. Long journeys are best, 
if the patient can bear them. 

3. Light emetics, repeated every second or third 
day ; white vitriol, in doses of 15 grains dissolved in 
half a tumbler of warm water. 

4. Mild laxatives every other morning ; the best ar- 
ticle is probably Epsom salts in small doses. 

5. A nourishing, easily digested, unstimulating diet 
— as milk, cheese-whey, eggs, broths, jellies, por- 
ridges, puddings, &c, and other kinds of food which 
the patient finds by experience to agree with him. 

6. A stimulating plaster worn between the shoul- 
ders. 

7. Expectorants and anodynes, which will allay 
coughing, and promote expectoration. Among the 
best of these is the pectoral mixture, or Dover's pow- 
ders. They should be accompanied with the free use 
of gum water, flax seed tea, &c. 

8. A new medicine, called hydriodate of potash, in 
steadily repeated doses, and the application of an 
ointment made of the same, over the diseased lung at 
the part affected. 

9. Inhalation of fumes of tar, of chlorine, and 
burnt sponge. 

10. Leeches applied over the part of the diseased 
lung most affected. 



DISEASES OF THE CHEST. 63 

If spitting of blood from the lungs occur at an early 
period, there is with it a tendency to inflammation. 
This must be prevented by measures of the most ac- 
tive kind. If the constitution do not positively forbid 
it, general bleeding should be employed, especially if 
the pulse be quick, although the patient may be feeble, 
since the weakness induced by spitting blood is not 
occasioned by the quantity that is lost. Blistering 
should then be employed ; the patient should be con- 
fined to a mild diet and quietude, and should avoid 
speaking, coughing, &c. The bowels are to be 
moved with cooling laxatives, as Glauber's or Epsom 
salts, and the patient kept in a uniform temperature, 
of from sixty to sixty-five degrees, and take half a 
grain of opium in the evening. After the above 
evacuations have been made, astringents and refriger- 
ants will be proper ; and when spitting of blood oc- 
curs in the latter stages of consumption, these are 
principally to be relied on. The astringents are elixir 
vitriol and alum ; the former in doses of twenty-five 
drops, in a gill of water, every three hours ; the latter 
in doses of six grains. As a refrigerant, common salt 
is a very effectual remedy, and should be given when 
spitting of blood has commenced, in doses of two or 
three tea-spoonfuls. 

In the latter stages of consumption, nothing more 
can be done than to palliate distressing symptoms. 
For the cough, take pectoral mixture and opium pills. 



SPITTING OF BLOOD, FROM THE LUNGS. 

SYMPTOMS. 

Sense of weight and oppression in the chest ; dry 
tickling cough ; difficulty of breathing ; flushed and 
anxious countenance ; sense of pain and heat refer- 
red to the breast-bone ; saltish taste in the mouth ; 
constant inclination to hawk and cough, by which 



64 DISEASES OF THE CHEST. 

blood from the lungs is raised. In this respect it 
differs from the vomiting of blood, the blood in that 
case being raised from the stomach without cough ; it 
is moreover sometimes clotted, and often mixed with 
alimentary matter. 

CAUSES. 

It may proceed from excess of blood, from a peculiar 
weakness of the lungs, hereditary predisposition, or 
bad formation of the breast. It is often occasioned 
by excessive drinking, running, wrestling, singing, or 
loud speaking. Sometimes it is the effect of a long 
and violent cough, and is then the precursor of con- 
sumption. 

TREATMENT. 

Administer table-salt, two or three tea-spoonfuls ; or 
alum, fifteen grains. One of these remedies will be 
sufficient to arrest the bleeding, for a short time. 

Draw blood from the arm on the first attack, and 
repeat the operation whenever there is any hardness of 
the pulse or other symptoms of inflammation, or any 
return of the disease, provided the quantity of blood 
already lost be not very great. 

After bleeding, open the bowels with a dose of Glau- 
ber's or Epsom salts, or cream of tartar. 

Refrigerants and astringents are then to be taken, 
as elixir vitriol, twenty drops, in a glass of water, every 
three hours ; or nitre, ten grains, dissolved in a glass 
of water, every three hours, adding to each dose, ten 
drops of laudanum. Also draughts of cold water 
with lemon juice. 

Carefully avoid heat, speaking, coughing, and every 
kind of bodily exertion. Use a light vegetable diet. 



DISEASES OF THE CHEST. 65 



COUGH. 

Commonly, this is only a symptom of some other 
disease, as of catarrh, consumption, &c. In such 
cases it is to be regarded in the general treatment of 
those complaints. In some constitutions, however, 
there is such irritability of the lungs, that cough is ex- 
cited on the least exposure to change of weather ; and 
in such, it often remains after every other symptom of 
a catarrh is removed. When long protracted and 
violent, there is always reason to fear the consequences, 
since it is often the precursor of consumption. 

TREATMENT. 

If the cough be violent, the patient young and ple- 
thoric, bleeding will be proper ; and it will be unsafe 
in such cases to administer opiates, to quiet the cough, 
till this is done or the stomach and bowels cleansed. 
In ordinary cases purging alone is often sufficient to 
prepare the system for opiates, and this may be in- 
duced by salts ; or sulphur, with cream of tartar, half 
an ounce of each, mixed in molasses, and taken in the 
evening. 

Emetics are among the most effectual remedies for 
a cough, and one alone is often sufficient to remove it, 
without the aid of other medicines; 

In long protracted coughs it will often be necessary 
to excite a counter irritation by a blister or irritating 
plaster. Burgundy pitch, spread on a soft leather, of 
the size of the hand and applied between the shoulders, 
will serve for this purpose : — Or, take common pitch 
of the ship, spread in like manner, and sprinkle on it 
two or three grains of the powder of tartar emetic, 
and apply it over the breast bone. An irritating plas- 
ter should be renewed once a fortnight. 

Opiates, combined with sudorifics, may be taken on 
going to bed, in the form of pectoral mixture, a table- 
spoonful ; or Dover's powders, ten grains, accompa- 
nied by warm drinks. 



66 DISEASES OF THE CHEST. 

Wear flannel next the skin — avoid exposure to 
sudden changes of temperature, and abstain from ar- 
dent spirits, and all strong stimulants, and from animal 
food. 



ASTHMA. 

SYMPTOMS. 



Tightness across the chest ; difficult breathing ; 
wheezing ; sense of suffocation ; cough, occurring in 
fits ; gasping for breath, that obliges the person to sit 
up until towards morning, when the symptoms abate 
and sleep follows. The fits recur for several nights, 
gradually losing their violence. There is not much 
danger in asthma, some of the French call it a lease 
for long life, yet it is apt to appear as a symptom of 
a dangerous disease of the heart. 



TREATMENT. 



To prevent asthmatic fits, avoid improper or too 
much food, especially suppers, exposure to damp cold 
air, fogs, great heat, or sharp vapors of any kind. 
When a fit is expected, emetics may ward it off, ex- 
pectorants should follow, as syrup of squills, wine of 
antimony and paregoric equal parts, garlic, strong 
coffee, ether. Smoking cigars made of stramonium 
give great relief. Bleeding will give temporary relief, 
and in full habits may be tried. In a saturated solu- 
tion of nitre or salt-petre, immerse some pieces of pa- 
per and let them dry? and then burn them near the 
patient, so that he may inhale the fumes. 



DROPSY OF THE CHEST. 

SYMPTOMS. 



Difficulty of breathing, particularly on any sudden 
exertion, as in ascending a hill, or stairs, or running ; 



DISEASES OF THE BELLY. 67 

it is also great during the night, while the body is in a 
horizontal posture ; distressing sense of weight and 
oppression at the chest ; palpitation of the heart, 
sometimes so great as to be seen and heard ; irregu- 
larity of the pulse, often intermissions ; paleness of 
the face ; dropsical swelling of the extremities ; scar- 
city of urine ; sudden starting from sleep ; fluctuation 
of water in the chest. 

TREATMENT. 

Employ the same medicines, that are advised under 
the head of dropsy. 



OF TYMPANY, OR WINDY DISTENTION OF THE 
BELLY. 

The wind may collect within the intestines ; or with- 
out them, in the cavity of the abdomen. In either 
case the belly, usually in a few hours, becomes greatly 
distended, tense and elastic, like a drum-head. Some- 
times the swelling is gradual in its progress and pre- 
ceded by rumbling of the bowels. There is dimin- 
ished appetite, thirst and emaciation. Unless the 
constitution be much impaired, the disease is generally 
curable. 

TREATMENT. 

The objects are, 1. To evacuate the air ; and 2. 
To prevent its re-accumulation. 

The first object is gained by heating medicines, as 
ether, anise-seed, peppermint, cayenne pepper, gin- 
ger, nutmeg, &c, and by opium; thus, paregoric 
two tea-spoonfuls, essence of peppermint twenty 
drops, powder of ginger half a tea-spoonful, mix in 
sugar, and take every three hours ; or, powder of 
rhubarb and ginger, of each five grains ; nutmeg, two 
grains ; opium, half a grain, mixed, to be taken every 
three hours. 



68 



DISEASES OF THE BELLY. 



To prevent the re-accumulation of air, after it has 
been once discharged, use tonics, as decoction of 
bark, or quassia, and avoid all food apt to produce 
wind. It is a disease of rare occurrence. In thirty 
years practice, I never have seen more than three 



cases. 



ASCITES, OR DROPSY OF THE ABDOMEN. 

SYMPTOMS. 

A slow, gradual swelling of the abdomen. When 
severe, there is thirst, scarcity of urine, and some de- 
gree of fever. 

CAUSES. 

The same as general dropsy, but the most usual is a 
diseased liver, occasioned either by the sudden appli- 
cation of cold, when the body has been heated, by a 
long protracted fever and ague, or remittent fever, or 
by hard drinking. 

It differs from tympany, in being almost invariably 
consequent to some constitutional disease ; is more 
slow and gradual in its attack, the belly is not so elas- 
tic, and there is a sense of fluctuation, and generally 
some dropsical appearances in the lower extremities. 

TREATMENT. 

The general treatment may be the same as is recom- 
mended under the head of general dropsy, to which 
may be added locally a tight-laced waistcoat, or tight 
bandages round the abdomen. This will serve to 
keep the disease in check, till the vessel arrives in port, 
where, if the swelling be very great, it may be advis- 
able to evacuate the water by an operation, which 
should be performed only by a skilful practitioner. 

The re'accumulation of water is to be prevented by 
the means recommended under the head of general 
dropsy. 



DISEASES OF THE BELLY. 69 

OF THE LIVER. 
ACUTE INFLAMMATION OF THE LIVER. 

SYMPTOMS. 

Pain in the right side, under the short ribs, which is 
increased by pressure ; sometimes it extends to the 
chest, then resembling pleurisy, and often there is pain 
in the right shoulder ; irregular state of the bowels ; 
inability of lying on the left side ; dry cough. 

The inflammation, if not reduced by the seventh 
or tenth day, usually ends in the formation of matter. 
In the former case, a bilious looseness ensues ; if an 
abscess form, it may break inwardly into the chest or 
abdomen, or outwardly through the skin. The most 
frequent cause is the hot and unhealthy climate of In- 
dia and China, and the neighboring islands. 

TREATMENT. 

Every exertion should be made to reduce the inflam- 
mation, as early as possible. Bleed, and purge freely 
with calomel and oil ; apply a large blister over the 
liver, or part affected with soreness ; and abstain from 
solid food and stimulants. In India, a salivation should 
be produced as soon as possible, with calomel and 
opium. 

If an abscess form and break, the patient's strength 
must be supported by bark and wine, and bitters, and 
elixir vitriol. When this disease has once attacked a 
person in hot climates, as India or China, he will often 
require the use of the blue pill, or of calomel, for years 
after. A change of climate is indispensable for the 
restoration of health. If the abscess point outwardly, 
and threaten to break through the skin, the part should 
be poulticed. 



70 DISEASES OF THE BELLY, 



CHRONIC INFLAMMATION OF THE LIVER. 

The attack of this is generally so gradual, and the 
symptoms at its commencement so obscure, as to pass 
long unnoticed. There is dejection of mind ; a loss 
of appetite ; rumbling in the bowels ; sense of weight 
and distention in the stomach ; obstinate costiveness ; 
clay-colored stools ; jaundice ; and oftentimes an en- 
largement of the liver, that can be felt. 

TREATMENT. 

Induce a slight spitting with mercury, applied by 
friction, and given internally ; thus, calomel pills, or 
four grains of calomel, or six grains of blue pill, every 
night and morning, and rub mercurial ointment, of the 
bulk of a nutmeg, on the inside of the thighs, every 
evening. 

Apply to the part a plaster of mercury or of pitch, 
of the size of the hand and thickness of a dollar. 



SEA-SICKNESS. 



With very few exceptions, this attacks all persons, 
on their first voyage ; and the degree of it is generally 
inversely proportioned to the size of the vessel, it 
being most violent where the vessel is small, and least 
so in large vessels, on which the waves make but slight 
impression. Some persons, however, are more liable 
to sea-sickness than others. Those in the prime of 
life, and of a fair, light complexion, have been re- 
marked to be most susceptible of its attacks, while old 
persons, and those of a dark complexion suffer least. 
The duration of sea-sickness is very uncertain, being 
generally not above a day or two ; but in many cases 
it continues for weeks, or even months, and there are 
some seamen who always suffer an attack in tempest- 



DISEASES OF THE BELLY. 71 

uous weather, even after having followed the sea for 
many years. 

TREATMENT. 

Though time is perhaps the only cure, various rem- 
edies have been directed to alleviate this complaint. 
In slight but lingering cases, in which nausea and 
headache continue a long time, without vomiting, it 
will cut short the symptoms to cleanse the stomach 
and bowels by a draught of sea-water ; and a tea- 
spoonful of ether, in a glass of water, will often re- 
he ve slight cases. The little food taken at a time 
should be eaten cold and highly seasoned, and the pa- 
tient should keep upon the deck, with his face to the 
windward. 

In severe cases, when no longer able to keep upon 
the deck, try a recumbent posture, resting the head on 
a book, or other hard substance, and continue as much 
as possible in a uniform position, with the eyes closed, 
and the thoughts engaged on some interesting and 
agreeable subject, till sleep comes on, or till vomiting 
has ceased. When the system has in this manner be- 
come accustomed to the rolling in one posture, and 
sickness has ceased, try another. In this way the 
rolling of the ship will cease to excite vomiting in a 
much shorter time than when the posture is continually 
changing. 

Dr. Johnson ascribes sea-sickness chiefly to the im- 
pression produced on the optic nerve, and transmitted 
to the brain, by the continued motion of the vessel, 
sails, shrouds, &c, and thinks that by keeping the 
eyes closed, this disagreeable nausea is frequently pre- 
vented. Dr. Maxwell regards it as a disease of de- 
bility, and recommends stimulants, such as brandy, 
and either to walk about, or to keep in a horizontal 
posture. 



72 DISEASES OF THE BELLY. 

ON THE STOMACH. 
INFLAMMATION OF THE STOMACH. 

SYMPTOMS. 

Fever ; anxiety ; heat and pain in the space between 
the pit of the stomach and navel, increased when any 
thing is taken into the stomach ; vomiting ; great 
thirst ; hiccup ; coldness of the extremities ; small, 
frequent, hard, and contracted pulse ; prostration of 
strength ; cold, clammy sweats. One of the most 
certain signs of this disease, is the sense of pain which 
the patient feels upon taking any kind of food or 
drink, especially if it be too hot or too cold. 

CAUSES. 

Cold liquids, drank when the body has been heated 
by exercise ; the operation of poisons taken into the 
stomach, as arsenic, or of acrid substances acting 
chemically there ; something acting mechanically and 
lacerating the coats of the stomach ; transfer of gout 
from the toe. 

TREATMENT. 

As twelve hours may, in some instances, carry off 
the patient, no time is to be lost in applying the reme- 
dies, which are : 

1. Copious bleeding ; to this the smallness of the 
pulse will be no objection, for it will become fuller by 
the loss of blood. 

2. A large blister, applied over the stomach. 

3. The use of the warm bath, even until fainting 
comes on. 

4. Mucilaginous drinks in very small quantities, and 
often, as flax-seed tea, barley-water, and gum arabic, 
dissolved in water, with a few drops of laudanum. 

5. Clysters of warm water. 

"Where poisons have been taken intentionally, or by 
accident, as opium, arsenic, corrosive sublimate, ver- 



DISEASES OF THE BELLY. 73 

digris, &c, administer an emetic immediately, of the 
most active kind, as white or blue vitriol, fifteen grains, 
dissolved in a gill of water, adding twenty grains of 
ipecac: drink freely afterwards of diluting liquors, as 
barley-water, toast- water, flax-seed tea, and milk. 



VOMITING OF BLOOD. 

SYMPTOMS. 



Vomiting of large quantities of clotted blood, and 
sometimes mixed with alimentary matter, generally 
unattended by cough, and preceded by a sense of 
weight and dull pain, or anxiety, a little below the pit 
of the stomach. 



CAUSES. 

Generally, some external violence ; or some me- 
chanical injury to the stomach itself, or some great 
strain of the body. 

TREATMENT. 

If accompanied by heat of the skin, or other symp- 
toms of fever, or if the disease can be traced to vio- 
lence or exertion, bleed and keep the patient cool, 
avoiding all causes of irritation. Unless the bleeding 
from the stomach become alarming from its quantity, 
it will be advisable not to arrest it by astringents, but 
suffer it to stop of itself. The day following, give a 
mild laxative, as of cream of tartar, castor oil, or a 
small dose of salts, to remove the blood from the 
bowels. 

Subsist for two or three days on light food, as bar- 
ley, rice, fresh broth, etc. When inflammation has 
subsided, give decoction of bark, or quassia, in a dose 
of two table-spoonsful every three hours, adding to 
each dose ten drops of elixir vitriol. 



74 DISEASES OF THE BELLY. 



HEART-BURN, AND SOUR STOMACH. 

These are caused by weakness of the stomach, and 
indigestion. 

TREATMENT. 

Take some alkaline substances, as powder of chalk 
or magnesia, a teaspoonful or two, or soda in water, 
and attend to the directions given under the head of 
Dyspepsia, or Indigestion. Abstain from stale liquors, 
acids, windy and greasy aliments, and take no exer- 
cise immediately after a full meal. 



OF THE INTESTINES. 
INFLAMMATION OF THE INTESTINES. 

SYMPTOMS. 

Severe pain in the abdomen, increased upon pres- 
sure, and shooting in a twisting manner round the na- 
vel ; hardness of the abdomen ; obstinate costiveness. 
There is sometimes vomiting or straining at stool, ac- 
cording as the inflammation happens in the superior 
or inferior portion of the intestine. The pulse is quick, 
hard and contracted, and the urine high-colored, and 
there are other symptoms of fever, with great prostra- 
tion of strength. 

CAUSES. 

All those inducing inflammation of the stomach, also 
strangulated hernia, colic, long continued costiveness. 

It is distinguishable from colic by being accompanied 
with fever, and by increase of pain from pressure. 

TREATMENT. 

The indications of cure are, 



DISEASES OF THE BELLY. 75 

1. To reduce the inflammation by bleeding once or 
twice from the arm, by a large blister laid over the 
belly, by the warm bath, and by total abstinence from 
stimulating articles of diet or medicine. 

2. To move the bowels by gentle purges, as castor 
oil, salts, or cream of tartar ; and by clysters of salt 
water. 



CHOLERA MORBUS ; OR VOMITING AND PURGING. 

SYMPTOMS. 

A frequent discharge of bile by vomiting and purg- 
ing, accompanied by pain and distention of the stomach, 
thirst, great anxiety, cramp in the lower extremities, 
cold sweats, hiccups, and not unfrequently death within 
the space of twenty-four hours. 

CAUSES. 

Exposure to excessive heat, or sudden transitions 
from heat to cold ; hence more frequent in autumn 
from exposure to cold evening ah*, after very hot days ; 
large quantities of food of difficult digestion ; the 
colder fruits, as cucumbers, melons, &c. ; active and 
violent purges ; poisons ; putrid annual food, as lob- 
sters ; exposure to the effluvia of putrid animal and 
vegetable substances. 

When it terminates favorably there is a gradual 
diminution of the symptoms, especially of vomiting, 
followed by sleep or a gentle moisture on the skin. 
The disease, when protracted to the fifth, sixth, or 
seventh day, seldom proves fatal. 

Unfavorable symptoms are strong cramps in the legs 
or arms ; convulsions ; great prostration of strength ; 
cold, clammy sweats ; intermitting pulse ; foetid vom- 
iting ; and great distention of the abdomen. 

TREATMENT. 

The first thing to be done is to remove offending 



76 DISEASES OF THE BELLY. 

substances from the stomach and bowels. This, how- 
ever, has in most cases been already effected by nature. 
If vomiting and purging have therefore occurred fre- 
quently, endeavor to allay the existing irritability by 
opium and diluting drinks. Begin with two tea- 
spoonsful of laudanum, mixed in gruel or tea, and 
repeat the dose every half hour till the vomiting is 
arrested. An excellent remedy is powdered sugar, 
chalk, and gum arabic, rubbed together — a table- 
spoonful of each in a gill of water till they form a sort 
of cream, add four tea-spoonsful of laudanum, and 
give a table-spoonful every half hour till the sickness 
abates ; give at the same time thin gruel, arrow-root, 
or chicken-broth frequently, but in very small quanti- 
ties. Laudanum and spirits of hartshorn, equal parts, 
mixed, are to be rubbed over the stomach constantly. 

When, in spite of this treatment, the vomiting con- 
tinues unabated for two or three hours, administer 
laudanum in clysters, thus : — 

Take laudanum, a half table-spoonful ; water, one 
pint, mixed ; inject one half, and direct the patient to 
retain it as long as possible ; when discharged, ad- 
minister the remainder. A large blister should now 
be applied over the stomach, the feet and legs bathed 
in warm salt water ; hot applications made to the feet ; 
opium given in pills, in a dose of five grains every 
hour, and the diluting drinks continued. The effer- 
vescing mixture ! should now be given every hour, 
adding to each dose twenty drops of laudanum. 

After the vomiting is allayed, give a mild purge, 
such as is most agreeable to the patient. 



SPASMODIC OR ASTATIC CHOLERA. 

As this disease commonly proves fatal even in the 
hands of skilful physicians on shore and in hospitals, 

1 See Appendix, 



DISEASES OF THE BELLY. 77 

where every known or supposed remedy is at hand, 
discouraging must be the prospect of treating it suc- 
cessfully on shipboard, by persons who are compara- 
tively ignorant of its nature, and of the virtues of 
medicines. Still it is the author's duty to furnish the 
best advice he can upon the subject. 

Cholera may be divided into three stages. 

1st. a premonitory, or threatening stage ; 2d. when 
it is fully formed ; 3d. a stage of collapse, or sinking. 

The first stage usually consists in a loose state of 
the bowels, which may continue several days, but is 
often of very short duration ; sickness or uneasiness of 
stomach, gripes, or severe pain at the pit of the stom- 
ach, are frequently added. The matters passed are 
such as are observed in ordinary diarrhoea and vomit- 
ing ; slight cramps may also be felt. 

The second is characterized by frequent vomiting 
and purging, almost always of a pale, whitish fluid, 
in great quantities ; by painful cramps of feet, legs, 
hands, arms, belly, or other parts ; a painful burning at 
the pit of the stomach ; the features are contracted 
and sharp ; the eyes sunk and surrounded by a dark 
circle ; apprehension, languor, and suffering are de- 
picted in the face ; the pulse, scarcely quickened, is 
feeble ; the surface, especially hands and feet, colder 
and perhaps of a darker color than natural ; there is 
great thirst, while drinks of every kind are generally 
vomited almost as soon as taken ; the breathing is slow, 
or not much disturbed ; the voice feeble, whispering, 
husky ; the secretions in general are suspended ; urine 
is not, apparently, formed ; hiccup is not unfrequent ; 
there is great tendency to sinking, and the person 
seems older than he really is. In some few cases, 
there is not purging ; in some scarcely any vomiting 
or cramp, the disease being chiefly marked by a pain- 
ful load, or tightness of chest and stomach, and a rapid 
sinking. 

The third stage, that of collapse, gradually succeeds 
to the second. In it the person seems to relapse into 



78 DISEASES OF THE BELLY. 

a state of tranquil heedlessness ; he will answer ques- 
tions correctly, even just before death, but with slow- 
ness ; the pulse is lost at the wrist and other parts ; 
the dark or blue color is more decided, yet in many 
this symptom is not observed ; the vomiting and purg- 
ing cease, or become less frequent ; " the skin is very 
cold, and generally damp, giving to the touch the 
sensation felt from handling a frog ;" the tongue, which 
is often furred, is cold ; even the breath is cold ; the 
fingers, hands, and other parts lose their usual plump- 
ness, and become shrivelled ; the patient tosses about 
incessantly, the breathing becomes laborious, and death 
takes place, in most cases, without any struggle. 

Such is the usual course of the disease, if left to 
itself, many varieties occurring in quickness and inten- 
sity. The first stage may be so short as to seem want- 
ing, or consist only in pain and cramp at the pit of the 
stomach. The second stage may not endure an hour, 
or extend to two or three days. The entire may end 
in death in two or three hours, or not for several days ; 
a long premonitory stage is not always followed by a 
mild form of cholera. 

When medicine is administered, and in rare cases 
without it, the progress is not so certainly towards death. 
In general a speedy convalescence may be predicted if 
attention be given in the first stage. A large propor- 
tion of deaths is clearly owing to the want of imme- 
diate assistance. 

If the first stage has been neglected, either by rea- 
son of its shortness, or its not causing alarm, not an 
instant should be lost ; the friends of the patient must 
not yield to the same fatal listlessness that is observed 
to seize on the person attacked. By proper means it 
is still probable that the natural tendency to collapse 
may be averted, the evacuations checked, the spasms 
moderated, and health restored. These changes may, 
as in the first stage, be speedy, the return to health 
being often preceded by tranquil sleep and free pre- 
spiration. 



DISEASES OF THE BELLY. 79 

Treatment in the first stage. — If it consist in purging, 
with occasionally slight vomiting, give a pill or a pow- 
der of calomel and opium, four grains of the former 
to one of the latter, and repeated as often as the stom- 
ach rejects it, and if the stomach retain it, repeat it 
every hour until a bilious discharge is produced, or 
the patient falls asleep. The person should keep warm 
in bed ; drink toast water, arrow root, rice water or 
barley water, and take nothing acid. Should the dis- 
ease not cease in an hour or two, but tend towards the 
second stage, with increased frequency of discharges, 
give three to five grains of acetate of lead, or of pow- 
dered alum, every two hours, and apply strong stim- 
ulants over the abdomen, as a plaster made of mus- 
tard and pepper-sauce or sharp vinegar, and rub the 
extremities with mustard and Cayenne, or with spirits 
of turpentine. 

In the second stage. — There should be administered 
injections of thin starch or gruel, containing two tea- 
spoonsful of laudanum to a pint, and repeated often, 
the calomel and opium repeated, mustard applied ex- 
tensively by mixing it in spirits of turpentine and pep- 
per-sauce and rubbed in hard over the limbs and 
trunk ; cloths dipt in hot water should be constantly 
applying, of greater heat than the attendants can bear 
their hands in, pieces of ice or cold water may be 
swallowed often. 

Treatment of the third stage will be a continuation 
of that of the second stage. Cayenne may be added 
to the calomel and opium, or aqua ammonia, (harts- 
horne) half a tea-spoonful in cold water, ether a tea- 
spoonful. 

The disease is not contagious, but endemic. It is 
apt to spread among a crew or other community, 
because they are alike exposed to one and the same 
atmospheric cause, but they do not communicate it to 
each other. 



80 DISEASES OF THE BELLY. 

COLIC. 
SYMPTOMS. 

The principal symptom is pain about the navel, 
generally violent, shooting and twisting, occurring in 
fits, during which the patient is disposed to bend down 
and press upon the part. The bowels are commonly 
costive, sometimes there is nausea with vomiting, and 
bitter taste in the mouth. 

CAUSES. 

Cold applied to the surface of the body, especially 
to the feet and belly ; crude or indigestible food ; re- 
dundance of bile ; obstinate costiveness ; flatulency ; 
certain metallic poisons, as lead and copper. Those, 
whose bowels are easily disordered, are liable to an 
attack of colic, from remaining in a room newly 
painted. 

TREATMENT. 

The first step is to allay the pain by opiates. Give 
opium and powder of camphor, of each two grains, 
mixed, every half hour, till the pain is relieved. 

Immediately after the second dose of opium, give a 
purgative of castor oil, three table-spoonsful, and if 
it fail to operate in three hours, give a fourth table- 
spoonful. Or, give such other purgative as is most 
agreeable. It will aid the operation of the medicine 
to dash cold water on the abdomen. 

In obstinate cases, it will be necessary to give still 
more active cathartics, as calomel from twenty to thirty 
grains, and to administer injections of salt water. 

Should vomiting ensue, and the pain still continue, 
apply a large blister over the abdomen, and immerse 
the patient in a w^arm bath. 

For a slight wind colic, a little spirits of camphor, 
or a few drops of peppermint, will often be sufficient. 



DISEASES OF THE BELLY. 81 

DIARRHOEA, OR LOOSENESS. 

SYMPTOMS. 

Frequent and copious evacuations by stool, gener- 
ally with griping ; oftentimes there is nausea and 
vomiting ; thirst ; bitterness and dryness of the mouth. 
If the disease continue, it produces great emaciation. 

CAUSES. 

The application of cold to the surface of the body, 
especially, if accompanied with moisture ; acrid, indi- 
gestible food ; great quantities of acid or cold fruits ; 
putrid substances. In the Mediterranean, it is often 
caused among sailors by drinking freely of new wine. 

The crew of the frigate Java, while lying at Syra- 
cuse, 1816, were put upon the use of new wine, in 
place of spirits, and nearly every man suffered an at- 
tack of diarrhoea. In other warm climates, as the 
West Indies, spruce beer, and other fermented liquors, 
often occasion it ; and in all climates, the sudden 
change from the long continued use of salt provisions 
to fresh meat and vegetables. 

TREATMENT. 

The cure consists, 

1. In obviating the cause. 

2. In suspending the inordinate action of the 
bowels. 

3. In restoring their strength and healthy action. 
Irritating causes are often lurking in the intestinal 

canal, and must be removed : 

1. By a cathartic, as rhubarb, magnesia, or castor 
oil, in a common dose, or by a draught of sea- water. 

2. By diluting drinks, as gruel, flax-seed tea, or 
barley-water. 

After the bowels have been cleansed by a cathartic, 
their inordinate action is to be suspended : 

1. By opium, conjoined with some medicine that 
7 



82 DISEASES OF THE BELLY. 

will produce sweating; thus, opium, from one to two 
grains, ipecac, three grains, mixed in syrup, or mo- 
lasses, and taken every three hours ; or, Dover's 
powder, 12 grains. 

In slight cases of diarrhoea, it will be sufficient, after 
cleansing the bowels, to take an opium pill in the 
evening, or twenty drops of laudanum. 

2. By astringents, as kino, twenty grains ; or lime- 
water, from four to six table-spoonsful ; or rhubarb, 
three grains ; or powdered alum, every three hours. 

When the disease proceeds from some error in diet, 
it will often terminate in a short time of itself, or per- 
haps the most that may be required in such cases will 
be a gentle laxative and gruel. 

To restore the strength : 

In severe cases where debility of the parts exists, 
their strength may be restored ; 1. By a decoction of 
bark, and other vegetable bitters, as columbo, quassia, 
ginseng, &c. 2. By moderate exercise. 3. Light 
nutritive diet, and port wine, should be substituted for 
malt liquors, as a common drink. 

The water of particular places often causes diarrhoea 
in ships' crews. The frigate Guerriere took a supply 
of water from the river Neva in Russia, and when it 
was used by the crew, about every sailor in the ship 
was affected with purging. In this instance and some 
other similar ones, I found that a pint of quick lime 
poured into each water cask corrected its purgative 
quality. Soaking burnt bread, or quenching burning 
coals in it, produced the same effect. 

The last of the ebb-tide furnishes water, both at 
Cronstadt and Canton, that is not purgative. 



DYSENTERIA. 

SYMPTOMS. 



Severe gripings, often preceded by loss of appetite ; 
sickness at the stomach ; costiveness, and chills ; fre- 



DISEASES OF THE BELLY. 83 

quent inclination to go to stool ; heat and irritation in 
the fundament ; appearance of stools various, being 
slimy, sometimes bloody, in this respect differing from 
those in diarrhoea, which are like common stools, only 
of a thinner consistence. Sometimes hardened lumps 
are discharged in the slime, and then the patient is 
momentarily relieved of his gripings. In some cases 
a film of hardened mucus is discharged, resembling a 
coat of the intestines. There is violent straining at 
stool, and the patient feels a bearing down, as if the 
bowels were falling out, and sometimes a part of the 
intestines is actually protruded. Great debility very 
soon ensues, with a quick and weak pulse. Sometimes 
it terminates fatally, and it is most severe when epi- 
demic. In India and the neighboring islands, it dif- 
fers in character from the common cases of temperate 
regions, the liver being more affected, and pouring 
out an excess of bile, often with blood, whence it is 
called bloody flux. 

CAUSES. 

It may be occasioned by whatever obstructs perspi- 
ration, as a damp bed, wet clothes, &c, also by unripe 
fruits ; bad air ; moisture succeeding intense heat ; 
unwholsome or putrid food ; the effluvia of vegetable 
or animal substances, in a highly putrid state. Per- 
sons living in crowded apartments, as in ships, are 
more liable to attacks. 

TREATMENT, 

Cleanse the bowels with calomel, ten grains, mixed 
in a table-spoonful of oil. If the pain be violent, give 
two grains of opium, mixed with the above ; or, in- 
stead of the above medicine, give the cooling mix- 
ture, 1 three table-spoonsful every half hour, till it ope- 
rates upon the stomach and bowels ; adding to the first 
dose, thirty drops of laudanum ; or, where there is 

1 See Mixtures in the Appendix. 



84 DISEASES OF THE BELLY. 

great aversion to an emetic, give castor oil, two table- 
spoonsful, with thirty drops of laudanum, and repeat 
the dose in three hours. 

Follow the use of the above medicine, with frequent 
and copious draughts of diluting drinks, as flour gruel, 
barley-water, flax-seed tea, &c. 

After clearing the bowels, give Dover's powder, 
eight grains every three hours, and a table-spoonful of 
oil every day, until the disease yields. 

In severe cases, where great pain and inflammation 
exist, after the stomach and bowels are cleared, a blis- 
ter may be applied over the abdomen, and fifteen or 
twenty drops of laudanum given every hour in the 
patient's drink, till relief is obtained. In less severe 
cases, instead of the blister, it may be sufficient to 
bathe the bowels with hot peppered vinegar, or hot 
water. 

Bleeding is a doubtful remedy in dysentery, and un- 
less the case be severe and the constitution vigorous, 
should not be employed. 

When there is great pain in the lower part of the 
abdomen and fundament, and the evacuations fre- 
quent, administer clysters of flax-seed tea, or barley- 
water, one pint, and laudanum a table-spoonful. Half 
of this is to be injected at a time, blood warm, and 
retained by the patient as long as possible. 

From the first attack the patient should abstain from 
solid food, and take freely of gruel, barley-water, 
arrow-root, flax-seed tea, or solution of gum arabic. 
The pulp of a roasted apple, or other ripe fruit may 
be taken. 

At a more advanced period of the disease, when 
the frequency of the evacuations seem rather to pro- 
ceed from a weakened and relaxed state of the bow- 
els, than from any active inflammation, the decoction 
of bark, or of quassia, may be given, every three 
hours, beginning with a dose of a table-spoonful and 
increasing gradually. It may be mixed in gruel or 
barley-water ; or give one grain of quinine, every three 
hours. 



DISEASES OF THE BELLY. 85 

When the pain and inflammation are abated and 
the stools are more natural, commence with animal 
broths, as of mutton, chicken, &c, at first thin and 
unseasoned, but gradually increasing their richness as 
the disease declines. 

Since the first edition was printed, I have acciden- 
tally met with a prescription in the hands of an irregu- 
lar practitioner which, so far as I have known, has 
never yet found its way into any printed medical book 
— I have made repeated trials of it, as have my pro- 
fessional brethren, and no medicine in our hands has, 
in all common cases, ever proved so successful. It is 
this. Mix with a small phial of water, as much sul- 
phate of zinc or white vitriol, as the water will dis- 
solve, take one part of this and five parts of lauda- 
num mixed — give to an adult fifteen drops every 
three hours, increasing the dose one drop daily — a 
dose of oil should precede the use of it, and should 
be repeated every other day, without omitting the 
drops. 

In India, where the disease is very prevalent and 
destructive, large doses of calomel, say twenty grains, 
are given with a grain of opium every six hours, and 
once in twenty-four hours a dose of castor oil. 

When this disease appears on board ship, it is of 
the first importance to prevent its being communicated 
to all hands on board ; to do this, the most assiduous 
attention should be paid to cleanliness. The evacua- 
tions of the sick must be immediately thrown over- 
board, and the buckets washed. Those who are well 
should avoid the night air as much as possible, shun 
putrid smells, and avoid all communication with the 
sick, and the privy to which the sick go. 



PILES, 

Are painful swellings at the lower extremity of the 
intestine or fundament, either internal or external. 



86 DISEASES OF THE BELLY. 

The internal are most painful, especially while at 
stool. When external, they vary much in size, being 
sometimes as large as a nutmeg. Frequently they 
break and discharge blood, which relieves the pain : 
the swelling however, does not then entirely disappear, 
and soon increases again to its former size. 

CAUSES. 

This complaint may proceed from habitual costive- 
ness, plethora, hard riding on horseback, strong aloetic 
purges, or sitting on damp ground. 

TREATMENT. 

As costiveness is the most frequent cause of piles, 
this must be obviated by mild laxatives, and none ap- 
pears to be more efficacious than the use of the pow- 
der of sulphur combined with an equal quantity of 
cream of tartar, mixed in molasses, in a dose of a 
table-spoonful every evening. Or take a gill of sea- 
water every evening. Another excellent internal re- 
medy is balsam of copaiva twelve drops, given twice 
in twenty-four hours dropt on sugar or in a glass of 
water. Aloetic purgatives should be avoided, and all 
family pills. 

As an application to the tumors, various ointments 
and washes are recommended, among which are the 
following. 

Sulphur and hog's lard, equal parts, well mixed, 
nutgalls and hog's lard, equal parts ; mercurial oint- 
ment, or fresh butter ; also, tar-water, alum-water, 
decoction of oak bark, lead water. A favorite appli- 
cation with many sailors is wet oakum. 

If the piles continue after the above treatment, and 
are very painful, apply leeches to the part, or if they 
are not to be had, make a small puncture in the tu- 
mors with a lancet, and after discharging their con- 
tents, apply warm poultices to the part. 

When the bleeding piles return periodically, once 
in three or four weeks, the discharge may be consid- 



DISEASES OF THE BELLY. 87 

ered salutary, and should not therefore be stopped, 
unless it becomes so excessive as to weaken the pa- 
tient, in which case the decoction of bark or of quas- 
sia, may be taken in doses of three table-spoonsful 
every two hours, adding to each dose ten drops of 
elixir vitriol. Alum or lead water, dissolved, added 
to a decoction of oak bark, is to be applied to the 
part, and injected in small quantity into the intestine, 
by means of a penis-syringe. 

In some instances, a falling down of the intestine 
will be a troublesome attendant on the piles, in which 
case the intestine must be immediately replaced after 
every evacuation, by pressing gently upon the part 
with the fingers, until it is reduced ; and its return 
must be prevented by astringent applications, as alum 
dissolved in vinegar, decoction of oak bark, sugar of 
lead dissolved. 

All the known causes, particularly costiveness, both 
during the disease and afterwards, must be studiously 
avoided. 



FISTULA. 



When the tumors mentioned in the foregoing 
disease have been suffered to inflame to a considera- 
ble degree, and by intemperance or ill treatment to 
ulcerate, a fistula is formed. In almost all cases of 
this disease, whether induced by piles, or other causes, 
the knife of a surgeon will be requisite. While at 
sea, however, and out of the reach of surgical aid, the 
patient, immediately on the least apprehension of a 
fistula, should keep his bowels open with mild laxa- 
tives of cream of tartar and sulphur, or small doses of 
castor oil taken every day ; should avoid every thing 
of a stimulating nature in food or drink, and take 
great care to irritate the part as little as possible, ap- 
plying at the same time lead- water externally. When 



88 DISEASES OF THE BELLY. 

in spite of this the inflammation proceeds on to ulce- 
ration, and pus is discharged from the fundament in 
such large quantities as to debilitate the patient, he 
should take bitters and wine, and support his strength 
with rich diet, till he can reach medical aid. 



HERNIA, OR RUPTURE. 

The part in which hernia most commonly appears 
is the groin. Generally the tumor takes a direction 
towards the scrotum, but sometimes it pushes into the 
front of the thigh ; the former is called inguinal, the 
latter femoral hernia. The contents of the tumor are 
a part of the intestine, or a portion of the omentum or 
caul, or both together. 

CAUSES. 

The most frequent causes in adults are blows, vio- 
lent exertions of strength, as lifting or carrying heavy 
weights, straining at stool, jumping, running, &c. 
When a rupture is produced by bodily exertion, the 
tumor is formed suddenly, and is generally attended 
with a sensation of something giving way at the part, 
and with considerable pain. 

TREATMENT. 

Reduce the tumor immediately by the hand. For 
this purpose the patient should be placed on his back, 
and the foot of the bed be elevated about twenty 
inches higher than the head, the thighs should be bent 
toward the body, and that on the same side with the 
rupture, inclined inwards. The pressure, which is 
made on the tumor by the hand of the operator for its 
reduction, should always be directed upwards and out- 
wards for inguinal hernia, and first backwards and 
then upwards in femoral hernia. If the tumor be not 
sooner removed, the pressure may be continued half 



DISEASES OF THE URINARY ORGANS, &C. 89 

an hour, but no violence is to be used, as it will tend 
greatly to aggravate the inflammation, — and the 
pressure, when it becomes painful, should for the 
same reason be discontinued. Should these efforts 
fail of success, the patient must be bled, and then 
another trial be made, and on failure of this also, use 
the warm bath, and repeat the effort while the patient 
lies in the water. Tne next remedies to be employed 
are, the coldest applications to the tumor, as ether or 
pounded ice, and where these cannot be obtained, a 
mixture of equal parts of nitre and common salt, in 
the proportion of half a pound of the mixture to a 
pint of water, kept constantly applied to the tumor. 
Finally, try an injection of tobacco made by boiling 
one drachm of tobacco in a pint of water for ten 
minutes. "When all these means fail, if a surgeon can 
be had competent to perform the operation for stran- 
gulated hernia, he should be called, and always within 
the first twenty-four hours. 

With the view of guarding against the dreadful 
consequences of a strangulated hernia, a ruptured per- 
son should immediately procure a well-adapted elas- 
tic spring truss, and wear it during the day, without 
intermission. 



DISEASES OF THE URINARY ORGANS AND GENITALS. 



OF THE URINARY ORGANS. 

INFLAMMATION OF THE KIDNEYS. 

SYMPTOMS. 

Fever, pain in the small of the back and thence 
shooting downward ; drawing up of the testicles ; 
numbness of the thigh ; vomiting ; commonly at first 
a deep red color of the urine, which becomes pale and 
colorless as the disease increases, and is discharged 



90 DISEASES OF THE 

very often with pain and difficulty ; costiveness and 
some degree of colic ; pulse frequent, hard and small. 

CAUSES. 

Acrid substances acting on the kidneys ; external 
injury ; long continued and violent exercise on horse- 
back ; violent exertions, strains, &c; but the most 
frequent cause is calculi or gravel, lodged in the kid- 
ney, or in the duct that leads from it to the bladder. 

TREATMENT. 

1. Bleed from the arm, and repeat the operation ac- 
cording to the urgency of the symptoms. 2. Admin- 
ister cathartics of the oily kind, as castor or sweet oil, 
and give glisters of barley-water, or flax-seed tea. 
When the pain is very great, administer a tea-spoon- 
ful of laudanum in the clyster. 3. Give copious 
draughts of diluting drinks, as flax-seed tea, and thin 
gruel, &c. 4. Let the warm bath be repeated ac- 
cording to the violence of the pain. The back should 
be bathed with flannels dipped in hot water. 



INFLAMMATION OF THE BLADDER. 

SYMPTOMS. 

Fever, acute pain, tension and tumor in the region 
of the bladder, frequent and painful discharges of urine 
in small quantities and inflammation in the funda- 
ment ; sometimes there is complete obstruction to the 
passage of the urine ; severe cases are attended by 
vomiting. 

CAUSES. 

Mechanical injury ; gravel ; the inflammation of a 
severe clap extended along the urethra to the bladder ; 
in some persons sudden cold will cause it. 



URINARY ORGANS AND GENITALS. 91 



TREATMENT. 



In severe cases adopt the same treatment that is re- 
commended in inflammation of the kidneys. In 
slight cases, proceeding from cold, or a clap, it may be 
sufficient to open the bowels. Inject the urethra and 
bladder with flax-seed tea, or barley-water, milk 
warm. Five or six penis-syringes full are to be fre- 
quently thrown in at a time, in order that some may 
pass into the bladder, where it is to be retained as 
long as possible ; and some kind of fluid is to be 
drank in frequent and copious draughts. After the 
bowels have been moved, laudanum may be given in 
doses of 40 to 60 drops. 



BLEEDING FROM THE BLADDER, OR BLOODY 
URINE. 

SYMPTOMS. 

When not the effect of violence, it is preceded by 
a sense of weight and pain in the loins. It is distin- 
guished from the high colored urine attendant on 
many diseases, by the deposite of a coagulum on the 
bottom of the vessel, and by its staining hnen of a red 
color. 

CAUSES. 

It is most frequently caused by gravel in the kidneys, 
but sometimes arises from external violence or great 
exertion. 

TREATMENT. 

If the disease be the consequence of injury, bleed 
and give a dose of Glauber's or Epsom salts, or of 
cream of tartar ; also, frequent and copious draughts 
of flax-seed tea, or barley-water, elixir vitriol, twenty- 
five drops every two hours, and an opium pill or 60 



92 DISEASES OF THE 

drops of laudanum, every four hours, till bleeding is 
arrested. If the discharge of blood be very great, 
give alum, 4 grains every two hours, dissolved in a 
gill of water, or sal nitre 10 grains. 

If no violence has been sustained to cause the dis- 
charge of blood, a vein need not be opened, but the 
other treatment must be adopted. 



INCONTINENCY OF URINE. 

SYMPTOMS. 

In this disorder the urine passes off involuntarily by 
drops, but does not exceed the usual quantity, as in 
diabetes, nor is the disease attended with pain. It is 
rather troublesome than dangerous. 

CAUSES. 

Sometimes it proceeds from blows and bruises, or 
is the effect of fever, or of strong stimulants on the 
bladder. In old people it may often be owing to a 
palsy of the neck of the bladder. 

TREATMENT. 

The most proper remedies are general tonics, as 
bark, quinine, or bitters, elixir vitriol, and cold-bath. 
Perhaps the most effectual remedy ever used is a blis- 
ter applied to the lower extremity of the backbone. 
It sometimes cures cases of long standing in twenty- 
four hours. Until these or some other means succeed, 
the patient should wear a sponge or bladder, to pre- 
vent excoriation of the parts. 



OF STRANGURY, OR SUPPRESSION OF URINE. 

It is called suppression, when there is an entire stop- 
page of urine ; and strangury, when there is a fre- 



URINARY ORGANS AND GENITALS. 93 

quent inclination to void it, and it is discharged in 
drops, with pain and difficulty. 

CAUSES. 

This complaint may proceed from a variety of causes ; 
as inflammation of the kidneys or bladder ; gravel, or 
small stones obstructing the urinary passages ; a spasm, 
or contraction of the neck of the bladder ; acrid injec- 
tions ; cantharides, either taken internally or absorbed 
from a blistering plaster. The particular symptoms 
attending it commonly designate the seat of the disease. 

TREATMENT. 

In all cases of suppression of the urine, it will be 
advisable to bleed from the arm, in quantity propor- 
tioned to the strength of the patient, and the urgency 
of the symptoms. This should be followed by gentle 
purgatives of salts, oil, or cream of tartar, by warm 
injections of barley-water, or flax-seed tea, by the 
warm bath, the patient sitting up to the middle in water, 
and by flannels dipped in hot water, and applied to the 
abdomen. Administer repeated doses of opium, or 
of laudanum, a tea-spoonful, mixed in warm drink, 
and repeat the dose every half hour, till it relieves. 
The application of ice to the feet and legs is highly 
recommended. 

If a suppression of urine do not yield to the above 
treatment, introduce a catheter or bougie, as directed 
under the head of Operations, and draw off the water. 

The diet, during the continuance of the complaint, 
should be of a light kind, and taken in small quantities. 



GONORRHCEA, OR CLAP. 

This disease is communicated from one individual 
to another by sexual intercourse, and is generally con- 
sidered a local affection. It sometimes commences in 

8 



94 DISEASES OF THE 

two or three days after the infection has been received, 
and at others, not before the lapse of several weeks ; 
but it commonly makes its appearance in between six 
and ten days. The first symptom is an itching at the 
orifice of the urethra, or urinary passage, and shortly 
after, there is a discharge from the part, of a thin, trans- 
parent matter, which soon becomes white, and after- 
wards changes to a yellow or green color. A slight 
degree of redness and inflammation begins to appear 
about the lips of the urethra, and a heat and smarting 
pain in most cases are felt in every attempt to make 
water. There is commonly a sense of fulness about 
the end of the penis, and frequently a soreness along 
the course of the urethra, accompanied with more or 
less pain in erection. 

In severe cases the erections become more frequent 
and lasting than in health, particularly when the patient 
is warm in bed, and the penis is curved downward 
with considerable pain, which is called chordee, and 
this is sometimes attended with a slight bleeding at the 
time of passing the urine. 

When inflammation runs high, the heat and scalding 
of the urine, as well as the chordee, are extremely 
troublesome ; there is a constant inclination to discharge 
urine, which is often attended with much difficulty, and 
sometimes it is rendered only by drops. There is also 
a sense of pain, heat, and fulness about the testicles 
and fundament, and the running is very copious, of a 
greenish and sometimes a bloody color. 

But in ordinary cases, where proper attention is paid 
to the disease, few or none of the last mentioned symp- 
toms occur, the disease merely consisting in a slight 
heat and scalding in making water, and a running, all 
which gradually subside, in ten or fifteen days. 

In consequence of violent inflammation, the prepuce 
or foreskin sometimes becomes so swelled, that it can- 
not be drawn back ; which symptom is called a phimo- 
sis ; or that being drawn behind the glans or head of 
the penis, it cannot be brought forward ; which is known 



URINARY ORGANS AND GENITALS. 95 

by the name of paraphymosis. The treatment of these 
will be given hereafter. 

A swelling of one or both testicles often arises in 
gonorrhoea in consequence of cold, severe exercise, or 
astringent injections. (For the treatment of this, see 
Swelled Testicles.) 

TREATMENT. 

On the first appearance of the clap abstain from 
every kind of high seasoned food, as well as stimulating 
liquors, and subsist on a mild, easy diet, as of milk, 
vegetables, broths, puddings, rice, &c, and commence 
taking freely of barley-water, flax-seed tea, or a solu- 
tion of gum arabic. Avoid all severe exercise, particu- 
larly walking, or riding on horseback, as well as vene- 
real intercourse, and even lascivious thoughts. 

During the inflammatory stage use injections of a 
mild and soothing kind, as flax-seed tea, new milk, or 
barley-water, blood-warm, repeating them as often as 
every two or three hours. In this stage also it is of 
importance to move the bowels every two or three 
days, with a mild purge, as castor oil, cream of tartar, 
or salts. 

If chordee be troublesome, take a grain of calomel 
and opium, on going to bed, and apply frequently to 
the extremity and along the under side of the penis, 
rags wet with a solution of sugar of lead, made with 
one drachm of the lead to a pint of water. 

When the inflammation runs very high, is attended 
with great pain and a constant inclination to make 
water, inject flax-seed tea and laudanum into the rec- 
tum, in the quantity of one gill of the former to a tea- 
spoonful of the latter, and continue the diluting drinks 
above mentioned. 

With this treatment relief will be obtained imme- 
diately, and the inflammation, in most cases, subdued 
in two or three days. After which, instead of the 
above, it will be advisable to use for the urethra one 
of the following injections : « 



96 DISEASES OF THE 

Sugar of lead and white vitriol, of each six grains, 
water one pint ; or ten grains of either may be used 
separately. 

These injections should be used cold every three or 
four hours. If employed before inflammation be sub- 
dued, they are apt to cause a swelling of the testicles. 

There are many practitioners, even at the present 
day, who maintain that gonorrhoea or clap, and the 
venereal disease or pox, are one and the same disease, 
arising from the same infectious matter ; and recom- 
mend the use of mercury alike in both. On this sub- 
ject, ten years very extensive practice in these com- 
plaints, on board ships of war, and twenty on shore, 
have served to convince me, that the two diseases are 
essentially different, and that a mercurial action, which 
may, in some cases, be necessary in the cure of pox, 
is of no sort of utility in gonorrhoea. 

Another mode of treating clap, and which I have 
more generally adopted of late years, is to give balsam 
copaiva, twenty drops, three times a day, on sugar or 
dropped on the surface of a wine-glass of water, to 
which a" tea-spoonful of spirits of nitre may be added 
— this, with a very abstemious course of living, and 
mild laxatives daily, as Epsom salts, will alone effect 
a cure without the use of injections. 



GLEET. 

When a clap is neglected, or ill treated, or the pa- 
tient irregular in his habits, it may continue for many 
months, and on subsiding leave a weakness and mu- 
cous discharge from the urethra, called a gleet ; it is 
unattended by pain or scalding, in making water, and 
is the consequence of relaxation. 

TREATMENT. 

It may be treated by stimulating diuretics, as bal- 



URINARY ORGANS AND GENITALS. 97 

sam of copaiva, and spirits of nitre, in a dose of 
twenty drops of the former, to a tea-spoonful of the 
latter, in a wineglass of water, three times a day ; by 
injections of blue or white vitriol and alum dissolved 
in water, made of such strength only, as to irritate the 
part in a slight degree. They are to be used four 
times a day, and continued many days after the run- 
ning has ceased. Cold water or ice should be applied 
near to the seat of the affection, night and morning. 



STRICTURE. 



Another evil to be apprehended from the long con- 
tinuance of clap, especially, if it has been attended 
with inflammatory symptoms, or has recurred fre- 
quently, is the taking place of stricture in the urethra, 
causing a partial and sometimes total closure of the 
passage. This complaint is particularly apt to follow 
those cases of clap, which are apparently cured, but 
which break out from time to time, in consequence of 
some irregularity in the patient's habits, as drinking 
freely of stimulating liquors, taking too much exer- 
cise, venereal gratification, &c. 

TREATMENT. 

The daily use of a bougie. Previous to its intro- 
duction, it should be slightly curved, and covered with 
oil, to prevent irritation. It ought to be worn at first 
for about half an hour, gradually increasing the time, 
from day to day. The size of the bougie is also to 
be increased, as the resistance to its passage becomes 
diminished. 

In those cases where a bougie, even of the smallest 
size, cannot be passed, as likewise in those of such 
long standing as to preclude the hope of a recovery 
from its use, recourse is to be had to the application 
of caustic, which is to be trusted only in the hands of 
a surgeon. 

8* 



98 DISEASES OF THE 



OF THE GEXITALS. 



SYPHILIS, OR VENEREAL DISEASE. 

CHANCRE. 

This disease is induced by the operation of a spe- 
cific poison, generally imbibed from an affected person 
during sexual inter course, and circulated through the 
whole system. In almost every case it first appears 
in the form of an ulcer or chancre, about the glans or 
head of the penis, frequently near the frenum or 
string. Generally a small itching pimple, containing 
a watery matter, is first discovered, which soon bursts, 
and leaves a circumscribed painful sore, but some- 
times the first appearance is an abrasion of the skin. 
The ulcer assumes a foul and rough appearance, with 
hardened edges, discharges a foul greenish matter, and 
differs from other ulcers, in its total indisposition to 
heal. The period of the appearance of chancre, after 
receiving the infection, varies from five or six days, to 
as many weeks. 

TREATMENT. 

This may be divided into general and local. In the 
former, which is by far the most important, mercury 
is not indispensably necessary, especially when the 
disease is recent. On the first appearance of chancre, 
the patient should take a dose of physic of a cooling 
kind, as salts or oil, and abstain from all stimulants, 
and from animal food, for several days. He should, 
on the day after taking the physic, apply the stick of 
caustic to the surface of the chancre ; the physic and 
the caustic may be repeated two or three times on the 
succeeding days. After each touch of the caustic, 
the chancre should be dressed with lint, besmeared 
with soft ointment or with tallow or oil ; and a soft 
rag wet several times a day in lead water should be 
applied over the part. In most cases this will effect 
a cure without the aid of mercury. 



URINARY ORGANS AND GENITALS. 99 

But if, from neglect of any part of the treatment or 
any other cause, the disease will not yield, — and one 
sign of this will be the appearance of a bubo in the 
groin, — then the patient must resort to the use of 
mercury. The best form of this will be the blue-pill 
at night and morning, and if it excites diarrhoea, ten 
drops of laudanum may be taken at bed-time. A 
calomel pill of two grains may be taken instead of the 
blue pill. 

With the view of hastening mercurial action in the 
system, blue ointment may be used in conj miction 
with the pills, and indeed, after one or two doses of 
the pills, it may be well to trust to the ointment alone. 
It may be used by rubbing a tea-spoonful of it on the 
inside of the thighs every day, for the space of five or 
ten minutes, continuing to wear the same drawers. 
This course is to be continued until some impression 
is made on the system, known by an uneasy feeling at 
the back of the head and neck, a slight coppery taste 
and clamminess of the mouth, and fetor of the breath, 
with perhaps a slight tenderness of the gums. Any 
action beyond this, such as salivation, or spitting and 
sore mouth, will do more harm than good. The 
slightest constitutional impression that can be made is 
the best ; and when this once appears, stop the mer- 
cury in every form for two or three days, when a blue 
pill or two may be given to preserve the slight mer- 
curial action, which should be continued a week or 
ten days. After this time it will be best to discontinue 
the mercurial course entirely for a week or two, even 
though the local disease be not cured, for the reason 
that the long continued use of mercury injures the 
constitution. It may however, be resumed in the same 
manner, and if necessary, for the same length of time, 
or until the local affection has entirely disappeared. 

During a mercurial course, abstain from high- 
seasoned food and spirituous liquors, and subsist on an 
easily digested diet, as fresh meat, broths, porridges, 
tea and biscuit, rice puddings, and fruit ; preserve a 



100 DISEASES OF THE 

pretty uniform temperature, and keep the clothing 
dry. 

If unluckily salivation be produced, or soreness of 
the gums, use a wash of weak solution of alum, and 
take sulphur and cream of tartar every evening. 

I have been thus particular about the use of mer- 
cury in syphilis, because I think it is likely to be used 
too indiscriminately. In former editions of this book, 
I recommended it in all cases of chancre ; but I am 
now convinced that in recent cases of chancre, it is 
almost always best to dispense with mercury ; and 
even in cases of bubo, if recent, it would be advisable 
to defer its use, provided there is any prospect of soon 
arriving in port where medical advice can be ob- 
tained, and where the patient can be less exposed to 
wet and cold while under the mercurial influence, and 
to adopt in the mean time the other remedies before 
mentioned. But in the commencement of whaling or 
other long voyages, it may be unsafe to defer the use 
of mercury as here directed. 

Avoid irritating the part by exercise, by sexual in- 
tercourse, and even by lascivious thoughts. 



PHYMOSIS. 



Not unfrequently it happens from neglect of large 
chancres on the head of the penis, that the prepuce or 
the foreskin becomes inflamed, and so contracted 
round the head of the penis that it cannot be drawn 
back, so as to expose the chancres to view, and admit 
of their being dressed. In such cases the general 
treatment recommended for chancres is to be continued 
as above directed, and warm water, containing a little 
soap, to be injected several times a day, between the 
skin and head of the penis, for the purpose of cleaning 
the part, and allaying inflammation. Warm poultices, 
made of flax-seed and pounded bread, should be ap- 



URINARY ORGANS AND GENITALS. 101 

plied to the part. Occasional attempts may be made 
to draw the skin back, and the penis be suspended 
against the body. If the inflammation be great, lose 
a pint of blood, and take a dose of salts. When these 
means fail to reduce the inflammation, and large ulcers 
exist under the skin, which cannot be brought to view, 
the stricture may be divided with a sharp instrument 
or scissors, its whole length, and the part bathed fre- 
quently in warm water, and poulticed three times a 
day, for two days ; after which, dress the wound with 
lint and simple salve, and the chancres as formerly 
directed. 

When the stricture or contraction is caused by the 
inflammation and discharge of a virulent gonorrhoea, it 
is to be treated in the same manner as above directed. 



PARAPHYMOSIS. 



This is a contraction of the prepuce or foreskin, back 
of the head of the penis, so that it cannot be brought 
forward. It is induced by the same causes as the pre- 
ceding disease. 

The same means are to be employed to reduce the 
inflammation as in phymosis, adding the frequent ap- 
plication with rags of sugar of lead, dissolved in water ? 
one drachm of the former, to four ounces of the latter. 
This and other cold substances are to be applied to the 
head of the penis, and occasional attempts are to be 
made to draw the skin over the part. 

If, notwithstanding this treatment, the swelling in- 
crease, there is danger of mortification ; the skin must 
therefore be divided by making an incision upon each 
side with a lancet, and the wound be treated as direct* 
ed after the operation for phymosis, 



102 



DISEASES OF THE 



BUBO. 



A bubo is generally the consequence of chancre, 
though sometimes it is the first symptom of the vene- 
real. It is a hard, painful tumour, seated generally in 
the groin. If not subdued the inflammation ends in 
the formation of matter. 



TREATMENT. 



As the ulcer formed by a bubo, that is suffered to 
break, is troublesome and difficult to heal, it is of the 
first importance to subdue the inflammation early, be- 
fore matter has formed. This must be effected, 1. By 
purgatives, as salts, or a draft of sea- water, taken every 
two or three days, and subsisting on a light diet, as 
broths, gruel, sago, barley, rice, puddings, &c. 2. 
By rubbing the inside of the thigh and leg with mer- 
curial ointment, in quantity equal to the size of a nut- 
meg, three times a day, continuing it with occasional 
omissions, as hereafter directed, till the bubo is nearly 
dispersed. 3. By cold applications to the bubo, as 
Epsom or Glauber's salts, laid on in a small bag, and 
frequently moistened with cold water and vinegar, or 
by a solution of salt and nitre in vinegar and water, 
used very cold, and applied with rags every hour. 
When these means fail to arrest the progress of the 
inflammation, we may hasten the formation of matter 
by applying caustic to the centre of the swelling, and 
when matter has formed, a soft poultice maybe applied, 
till the abscess is about to break, when a small puncture 
is to be made with a lancet, in the most depending part, 
and Basilicon ointment applied on lint. If after some 
days the swelling continue, apply over it a thick cover- 
ing of mercurial plaster, spread on soft leather, leaving 
an orifice in the centre over the sore for the discharge 
of matter and the introduction of lint. 

A mercurial action is generally deemed necessary 
in buboes, but as they are a long time in subsiding, not 



URINARY ORGANS AND GENITALS. 103 

imfrequently some months, a constant mercurial action, 
kept up all this time might create an unnecessary de- 
bility of the system ; besides this, it sometimes hap- 
pens, that from the long continued action of mercury 
upon the system, the sore turns to what is termed a 
mercurial ulcer, and is then aggravated, rather than 
benefited, by the medicine. In buboes of long stand- 
ing, therefore, after having excited a slight mercurial 
action by friction, as above directed, and continued it 
for some days, omit the unction for a week or ten days, 
and then return to it for five or six days only at a time. 
The degree to which mercurial action should be ex- 
cited, need be only till a copperish taste and some fetor 
of breath appear. The same precautions are necessary 
in regard to exposure to cold and moisture, that are 
mentioned in the treatment of chancres. 



SWELLED TESTICLE. 

It may be induced by any of the common causes of 
inflammation, but is more frequently brought on by the 
use of strong urethral injections, or incautious intro- 
duction of bougies. It often follows a sudden sup- 
pression of the gonorrhceal discharge from cold ; sit- 
ting on wet grass often occasions it. 

TREATMENT. 

The patient should confine himself to a spare diet, 
and remain in a recumbent posture, with the part su- 
pended or triced up, by means of a bag- truss or band- 
age. The bowels should be moved by a dose of salts, 
and if inflammatory symptoms run high, general bleed- 
ing will be necessary. One of the best local applica- 
tions is Epsom or Glauber's salts, laid on the part in a 
small bag, and frequently moistened with cold water. 
A strong solution of sugar of lead may be applied 
cold, every ten minutes, by means of rags, immersed 
in the liquid. 



104 DISEASES OF THE 

When the disease proceeds from the sudden sup- 
pression of a clap, a return of the running is to be 
favored by injections of warm flax-seed tea. 

Should the swelling continue increasing and matter 
appear to be forming, the part is to be bathed and 
poulticed. 



DROPSY OF THE SCROTUM, 

Is an accumulation of water, first perceived at the 
bottom of the scrotum, which gradually increases, and 
gives the part a pyramidal shape ; a distinct fluctua- 
tion is generally to be distinguished. There is no pain 
or discoloration, and in viewing the parts near to a 
strong light a transparency is observable. 

TREATMENT. 

At the commencement of the disease, and when a 
small quantity of fluid only is collected, it may some- 
times be dispersed by cold and stimulating applications, 
as sal ammoniac, dissolved hi vinegar and spirit ; ni- 
tre, or Epsom, or table-salt dissolved in the same fluids, 
applied cold very frequently with soaked rags. In 
general, however, it will eventually become necessary 
to evacuate the fluid by an operation. 



DISEASES OF THE LIMBS AND LARGE JOINTS. 



RHEUMATISM. 

There are two lands : acute, which is inflammatory, 
and of short duration ; and chronic, which is of long 
duration, and accompanied by debility. 

SYMPTOMS OF ACUTE RHEUMATISM. 

They commence with slight fever ; very soon fol- 



LIMBS AND LARGE JOINTS. 105 

lowed by an inflammation, sharp pain, and swelling in 
the neighborhood of one or more of the large joints, 
and this pain increases when the patient becomes warm 
in bed. It is variable, shifts from joint to joint, and 
leaves the part it occupied, swollen, red, and tender to 
the touch. The joints most subject to this disease, 
are the hip, loins, back and shoulder. The pulse is 
full and hard, the tongue has a slight whiteness, the 
urine is high colored, the blood, when drawn from a 
vein, exhibits a light colored crust on its surface ; cos- 
tiveness prevails ; and sometimes there is profuse 
sweating without relief. 

CAUSES. 

Obstructed perspiration, occasioned by wearing wet 
clothes, lying in damp linen or damp rooms, or by 
being exposed to cold air, while heated by exercise. 
Sailors are particularly liable to this complaint, on ac- 
count of their frequent calls upon deck in rainy weather, 
and sleeping in wet clothes. Often it attacks sailors 
on their approach from a warm to a cold climate. 

TREATMENT. 

This is to be commenced by bloodletting and purg- 
ing ; the quantity of blood to be taken from a sailor, 
may be between one and two pints, according to the 
strength of his constitution and the violence of the at- 
tack, and if the symptoms continue unabated, the ope- 
ration may be repeated on the following day. As a 
cathartic, give a dose of salts, or of castor oil, or 
flowers of sulphur and cream of tartar, half an ounce 
of each mixed with molasses. When the bowels have 
been moved, take Dover's powders, eight to twelve 
grains every four hours, and drink freely of warm herb 
tea and toast- water, or barley-water and gruel. An- 
other remedy of great value in acute rheumatism, is 
opium, one grain, taken every three hours, keeping 
constantly warm in bed, and drinking freely of herb 
9 



106 DISEASES OF THE 

teas, until the pain is carried off by profuse sweating. 
This course should be preceded by a cathartic. 

When fever has subsided, and the pain is confined 
to one part, blisters will prove useful. Warm fomen- 
tations tend rather to aggravate the pain of acute 
rheumatism. The patient should subsist on a low 
diet, abstain from stimulating drinks, and preserve an 
open state of the bowels by occasionally repeating the 
purgatives before recommended. 

When the inflammatory symptoms have subsided, 
the patient may return to a generous diet, and the use 
of .wine and strengthening medicines. 

In approaching a cold climate, the master of a ves- 
sel should attend to the clothing of his crew, and see 
that its warmth increases in proportion to the coldness 
of the weather ; he should also prevent the men's 
sleeping on damp beds, or in wet apparel. If woollen 
shirts are best for sailors in all climates, they are more 
particularly so in approaching from a warm to a cold 
one. 



CHRONIC RHEUMATISM. 

It may be either a consequence and termination of 
the acute rheumatism, or it may be independent of it. 
In the first case, the parts which were affected with 
inflammation, are left weak, stiff, in some instances 
swelled, and the pain, before movable, is now usually 
confined to particular parts : sometimes, however, it 
still shifts from joint to joint, but is unattended by any 
inflammation or fever. When not the consequence of 
acute rheumatism, it is most commonly met with in 
people at the decline of life. The pains are felt in the 
large joints, which are increased upon motion, and 
relieved by artificial warmth ; the part affected is pale 
and cold, even when the other parts of the body are 
Warm. 



LIMBS AND LARGE JOINTS. 107 



TREATMENT. 

This must differ from that which is recommended 
in acute rheumatism. General bleeding, as well as 
much purging, will be inadmissible. The part affected 
may be rubbed several times a day with volatile lini- 
ment, or with spirits of camphire, and the part rolled 
in flannel. In long continued and obstinate rheumatic 
affections, leeches applied to the part will be service- 
able, as also blisters kept constantly running. A val- 
uable application to the part is a plaster of common 
pitch, spread as thick as a dollar on soft leather, and 
sprinkled over with tartar emetic, five grams to a sur- 
face as large as the hand. 

These local applications must be accompanied with 
such internal medicines as are best adapted to stimulate 
and warm the system and alleviate pain. Gum guai- 
acum is one of the most powerful general stimulants, 
and may be taken in doses of fifteen grains, or a small 
tea-spoonful of the powder mixed with sugar, molasses, 
or gruel, every three hours. Or take of the tincture 
of Guaiacum from two to four tea-spoonsful, in wine 
or gruel. Mustard and horse-radish may be used 
freely. 

The diet should be rich and stimulating ; flannel 
worn next the skin : and exposure to cold night-air, 
wearing damp clothes, and wetting the feet, should be 
carefully avoided. 

To relieve pain and promote sleep, take Dover's 
powders, ten grains on going to bed. Or a pow^der 
of calomel, ipecac, and opium, of each one grain. 

In the winter season a warm climate would prove 
highly beneficial. Such persons who wish to make 
the tour of Europe, would find Italy a suitable resi- 
dence — Barcelona, Valencia, in Spain, and the whole 
shore of France, from Pau to Piedmont, are good. 



108 DISEASES OF THE 



SPRAINS. 

Are violent stretchings or twistings of joints, followed 
by painful swellings. They are often attended with 
worse consequences than broken bones, on account of 
then being more neglected. When a bone is broken, 
the limb is kept easy, because it is useless ; but when 
a joint is sprained, it is still used, by which it may 
finally be rendered incurable. 

The most essential measure is perfect rest, and to 
insure this, if the case be at all serious, the part may 
be confined by a pasteboard splint. Warm bathing 
generally gives more relief than cold. If inflamma- 
tion run high, or a large joint is affected, leeches or 
bleeding and general cooling measures must be 
adopted. Afterwards liniments may be useful, mod- 
erate exercise, and bandaging with flannel. 



DISLOCATIONS OF THE LOWER JAW. 

The lower jaw may be disjointed by yawning, or 
blows. It is readily known by the patient's inability 
to shut his mouth — a want of correspondence of the 
patient's teeth — hanging down of the chin, which is 
sometimes turned to one side — inability to speak dis- 
tinctly, or to swallow without considerable difficulty. 

The bone may be replaced by sitting the patient 
upon a low stool, so that an assistant may hold the 
head firmly against his breast. The operator is then 
to thrust his two thumbs, previously wrapped in linen, 
far back into the patient's mouth, and, applying the 
fingers to the jaw externally, is to press it strongly 
downwards and backwards, by which the dislocated 
heads of the jaw may be easily forced into their pro- 
per cavities. 



LIMBS AND LARGE JOINTS. 109 



DISLOCATION OF THE SHOULDER. 

The humerus or upper bone of the arm may be dis- 
located in various directions ; it happens, however, 
most frequently downwards, and very seldom directly 
upwards. From the peculiar structure of the joint, 
as well as from its exposure to external injuries, this 
bone is the most subject to dislocation of any in the 
body. A dislocation may be known by a depression 
or cavity on the top of the shoulder, and an inability 
to move the arm. When it is downward or forward 
the arm is lengthened and a swelling is perceived un- 
der the arm-pit, when it is backward, there appears a 
protuberance behind the shoulder and the arm is 
thrown forward toward the breast. The two shoul- 
ders should be carefully compared. 

TREATMENT. 

A bandage or strong belt is to be passed under the 
arm-pit of the injured side, and carried over to the 
opposite shoulder, a common roller towel or strip of 
sail cloth will answer. A second belt or strong hand- 
kerchief is to be tied round the dislocated arm, just 
above the elbow. By the latter of these, a gradual 
extension must be made by one or two persons, in a 
direction obliquely downwards and outwards ; the 
body being at the same time kept immovably fixed, 
by assistants drawing the former belt in an opposite 
direction. After this extension has been kept up for 
a short time, during which it should be gradually in- 
creased in force, the operator is to lift the head of the 
bone into its cavity. 



DISLOCATION OF THE ELBOW. 

The bones of the fore-arm may be dislocated in 
almost any direction. When this is the case, a protu- 
9* 



110 DISEASES OF THE 

berance or hard swelling may be observed on the side 
of the arm to which the bone is pushed. It may be 
known by the patient's inability to bend the arm, and 
by comparing its shape with the other elbow. 

Extension is to be made by assistants pulling grad- 
ually in opposite directions, while the operator returns 
the bones into their proper place. Afterwards the 
arm must be bent and suspended for some time with 
a sling about the neck. 

Luxations of the wrist and fingers are to be reduced 
in the same manner as those of the elbow ; viz. by 
making an extension in opposite directions, and thrust- 
ing the head of the bone into its place. 



DISLOCATION OF THE THIGH. 

When the thigh bone is dislocated forward and 
downward, the knee and foot are turned out, and the 
leg is longer than the other ; when it is displaced 
backward, it is usually pushed upwards at the same 
time, by which the limb is shortened, and the foot is 
turned inwards. 

When the thigh bone is displaced forward and 
downwards, the patient, in order to have it reduced, 
must be laid upon his back, and made fast by band- 
ages or held by assistants, while by others extension 
is to be made by means of slings fixed about the 
thigh, a little above the knee. While the extension is 
making, the operator must push the head of the bone 
outward, till it enters the socket. If the dislocation 
be outward, the patient must be laid upon his face, 
and during the extension, the head of the bone must 
be pushed inward. 



LIMBS AND LARGE JOINTS. Ill 

DISLOCATIONS OF THE PATELLA, OR PALM-BONE 
OF THE KNEE. 

The patella may be thrown out of its place either 
sideways or upwards ; in the latter case, the ligament 
with which it is connected is broken, and the bone is 
drawn up severa] inches among the muscles of the 
thigh. The nature of the case can be distinctly as- 
certained, both by the sight and feeling. 

TREATMENT. 

In the dislocation sideways, the limb must be firmly 
extended ; when, pressure being made upon the pro- 
truding edge, the bone immediately regains its former 
situation. 

When the dislocation is upwards, it is to be treated 
precisely as a transverse fracture of the bone ; which 
see. 



DISLOCATION OF THE KNEE-JOINT. 

The principal bone below the knee may be partially 
dislocated, either inwards, outwards, or backwards. 
In either case it is obvious to the sight. It very rarely 
occurs. 

Extension is to be made upwards, by the thigh, and 
downwards, by the leg, while the bones are replaced 
by pressure with the hand. 



DISLOCATION OF THE ANCLE. 

A dislocation of this joint may take place, either in- 
wards, outwards, or forwards. 

The two former cases may be ascertained by the 
inclination of the foot, and by the unnatural protu- 
berance on one side, and deficiency on the other. 



112 FRACTURES. 

When the end of the bone of the leg is forced for- 
wards on the foot, the instep will be observed to be 
considerably shortened ; and there is a great and un- 
usual projection of the heel. 

The bone is to be replaced by extension, made in 
the same manner as in dislocation of the knee. 



DISLOCATION OF THE THUMBS, FINGERS, AND 
TOES. 

These are to be replaced by making extension, at 
the same time gently bending the joint, and applying 
pressure with the thumb upon the end of the bone, 
that is out of place. 



FRACTURES, OR BROKEN BONES. 

GENERAL REMARKS. 

In the fracture of a large bone, the patient should 
be put upon a light, unstimulating diet, and if young 
and plethoric, he may be bled. He should be kept 
dry and clean, that the parts which bear hard upon 
the bed may not be galled. While at sea, where the 
ship is rolling, it will be indispensably necessary for 
him to swing in a cot. It has been customary with 
many to keep the limb continually upon the stretch, 
but this posture is uneasy to the patient and unfavora- 
ble to a cure. It will be preferable to keep the limb 
a little bent, either by laying the patient upon the side, 
or by making the bed so as to favor this posture. 
The dressings of the fracture should be re-applied 
every three or four days, or oftener if they become 
loose, and the lint should each time be wet with some 
cooling wash, as a solution of sugar of lead, or vine- 
gar and water. 



FRACTURES. 113 

OF FRACTURES. 
FRACTURE OF THE BONES OF THE NOSE. 

When the bones of the nose are broken in, they 
may be raised to their place by means of a quill, or 
other instrument introduced by the nostril, and in gen- 
eral they will retain their situation, without any further 
assistance. 



FRACTURE OF THE LOWER JAW. 

The nature of the injury is obvious to the sight, 
The parts being accurately replaced, and kept firm by 
an assistant, a thick pad of lint should be placed over 
the seat of the fracture, and a bandage applied, by 
means of which the jaw may be firmly held upwards 
and backwards ; for this purpose the most effectual is 
a bag or purse, to receive the chin, with four tapes, or 
ends, attached to it ; the two inferior of which are 
tied over the top of the head, and the two superior 
carried back of the head. 

During the cure, the patient should be kept quiet, 
and not suffered to exercise his jaws in chewing his 
food. 



FRACTURES OF THE CLAVICLE OR COLLAR-BONE. 

The existence of its fracture may be known by 
tracing the collar-bone along with the fingers, when 
one of the fractured ends will be found to project 
over the other, and a crackling noise of the bones 
will be perceptible. 

TREATMENT. 

The arms and shoulders of the patient, are to be 



114 FRACTURES. 

firmly drawn backwards by an assistant, when the 
fractured ends immediately come in apposition. The 
part is now to be covered with a thick adhesive plas- 
ter or one of common pitch, and a bandage is to be 
applied to retain the bones in their place. The ban- 
dage should be long, and commencing with it on the 
part injured, is to be carried under the arm-pit, across 
the back, and over the other shoulder, then under the 
arm-pit of that side, and back over the injured shoul- 
der ; thus describing on the back the figure oo. The 
turns should be repeated two or three times, and be 
drawn with considerable tightness, and the arm should 
afterwards be supported with a sling from the neck. 



FRACTURE OF THE RIBS. 

The characteristic mark of a fracture of the ribs is 
the crackling or grating of the bones, which may be 
distinctly felt and heard, upon the patient's coughing, 
or during a deep inspiration, and by a sharp pain of 
the part, at the same moment. 

TREATMENT. 

In this, the principal attention is to be directed to 
the general symptoms. Bleeding in almost all cases 
is necessary, and such other means should be adopted 
as are calculated to allay inflammation, as gentle 
purging, and abstinence from the use of stimulants, 
An adhesive plaster may be applied over the fracture, 
and the body tightly encircled with a broad bandage. 



FRACTURE OF THE ARM, BETWEEN THE SHOUL- 
DER AND ELBOW. 

This fracture is simple and easily recognized. In 
order to bring the fractured extremities into their 



FRACTURES. 115 

place, a slight extension should be made, with the 
elbow bent at a right angle. The arm is then to be 
encircled with a piece of soft flannel, or cotton, and 
two splints applied, one on the inside, and the other 
on the outside of the arm. They may be made of 
pasteboard or thin slips of wood, an inch and a half 
broad, and to extend the whole length of the bone, to 
be bound on with a bandage. The forearm should be 
suspended by a handkerchief from the neck, in such 
a manner that the wrist may be more supported than 
the elbow, so that the weight of the arm counteracting 
the contraction of the muscles, may serve to keep the 
ends of the bone in their proper place. 

The bones should be retained in their place for two 
weeks, by which time it will be united. 



FRACTURE OF THE ELBOW. 

The fracture of this is readily known. The piece 
of bone will be found drawn upward. It is to be re- 
placed and confined by a bandage rolled round the 
limb, as directed in fracture of the patella, and the 
arm should be kept nearly straight, by means of a 
splint bound upon the inner side, and extending near- 
ly to the hand and shoulder. By persevering in this, 
the knob of bone forming the elbow, will be joined 
to the arm from which it has been broken. 



FRACTURE OF THE BONES OF THE FOREARM. 

The existence of a fracture of these bones may be 
known, by tracing the course of the bones with the 
fingers, from the elbow to the wrist, comparing the 
limb with the other, and by the crackling or grating 
of the ends of the bones against each other. 

The same treatment is required as in fracture of the 



116 FRACTURES. 

arm between the shoulder and elbow. The splints 
should be laid one on the inside, and the other on the 
outside of the arm ; so that both bones may be at once 
effectually compressed ; that on the inside should 
reach to the palm of the hand, by means of which the 
wrist will be kept steady, and the bones prevented 
from rolling on each other. They may be confined 
by a bandage rolled round the limb, and the arm 
worn in a sling. The splints should be loosened every 
day, and the arm bathed in cold water or vinegar. 



FRACTURE OF THE BONES OF THE HAND AND 

FINGERS. 

The fracture of the bones of the hand are readily 
replaced, and may be easily preserved in their natural 
situation, by accurately adapting a pad or cushion to 
the palm of the hand, and applying a bandage over 
all, beginning at the wrist, and extending it to the 
fingers. 

When the fingers are broken, they are to be neatly 
set with pieces of pasteboard, moistened ; over which 
a small roller is to be applied. 



FRACTURE OF THE THIGH-BONE. 

The existence of this fracture may be known by the 
crackling or grating of the broken ends, made in 
moving the limb, and by a projecting point that may 
be felt on the inside of the thigh. Also, by the ina- 
bility of the patient to cross the injured limb over the 
other. 

TREATMENT. 

The patient should, if possible, be moved to a cot, 
since a common fixed birth will hurt the limb during 



FRACTURES. 117 

the motion of the ship, and a hammock is rendered 
objectionable by its curved shape. The patient thus 
conveniently situated, a gentle extension is to be made 
by an assistant, while the operator replaces the bones 
in exact apposition, and applies over the limb a soft 
rag wet with a strong solution of sugar of lead ; and 
over this, the many- tailed bandage, made in the fol- 
lowing manner : — take common rollers or bandages 
of cotton, two inches wide, and of sufficient length to 
pass round the limb, and lap over, two or three 
inches ; spread as many of these by the side of each 
other, as will extend from near the groin to the knee. 
Another bandage of the same kind is then to be laid 
across, and stitched to them. The whole are now to 
be placed under the thigh in such a manner, that the 
cross bandage shall stretch along under the bone, and 
each of the tails is to be brought separately over the 
limb, beginning at the one next the knee, and crossing 
it by the one opposite. When all the tails are thus 
brought over, and made fast with pins, three splints 
are to be applied, one on each side, and a third on the 
top, that on the outside being of sufficient length to 
reach from the hip to the knee. These being tied 
firmly with tapes, the limb may now be placed, either 
in a straight position, or in a fracture-box, shaped like 
the roof of a house, with the knee bent to a consider- 
able angle, which is preferable ; or the thigh may be 
laid smoothly upon a pillow, on one side, a little out 
from and higher than the body. The limb must re- 
main in this position for several weeks. If possible a 
surgeon should be called soon after the fracture, as it 
may lead to the prevention of a crooked limb. 

Fractures of the bones of the leg beloiv the knee, are 
to be treated in nearly the same manner as the 
above. 

10 



118 FRACTURES. 

FRACTURE OF THE PATELLA, OR PALM-BONE OF 
THE KNEE. 

The fracture is generally transverse, and rarely long- 
itudinal. In the former case the upper portion is 
drawn up several inches among the muscles of the 
thigh. 

TREATMENT. 

In the longitudinal fracture, continued extension of 
the limb and the application of a bandage to the knee 
will be sufficient to effect a speedy union. 

In cases of transverse fracture, owing to the great 
separation of the divided portions, it is extremely 
difficult, and nearly impracticable to effect a union by 
bone. The fractured portions being made to approach 
each other as nearly as possible, the middle of a band- 
age of considerable length is to be applied over the 
upper part of the patella, and being carried round the 
thigh just above the joint, it is to be crossed under the 
ham, and carried round below the knee, so as to draw 
the fractured portions together, and having thus de- 
scribed the figure oo around the joint, it is to be firmly 
secured and daily increased in tightness. 

As it will be necessary to keep the limb constantly 
extended ; a splint, lined with tow, wool, or cotton, 
may be applied under the ham, and made fast to the 
limb with tapes. 

A fracture of that projection of bone that makes the 
elbow, may be treated in nearly the same manner. 



DISEASES OF THE SKIN. 



ERYSIPELAS. 

SYMPTOMS. 

It begins with symptoms of fever, confusion of the 
head, sometimes delirium, sickness at the stomach. 



DISEASES OF THE SKIN. 119 

About the second or third day, the skin of some part 
of the body, generally the face, becomes inflamed. 
The redness commences about the eyes and nose, or 
one of the ears, is attended with itching and burning, 
and extends from the forehead to the mouth. If the 
disease continue, the whole of the head becomes in- 
flamed, and often one or both eyes are closed. As the 
redness extends, it frequently leaves or is abated in the 
part it at first occupied. After a longer or shorter 
time, the redness terminates in small watery pimples, 
or in a scaling of the skin. The fever, however, does 
not always at this period suffer a remission, but on the 
contrary, is frequently aggravated, and sometimes the 
patient expires about the ninth or eleventh day. 

TREATMENT. 

Reduce the inflammatory state of the system by 
cooling, or mercurial purges, as calomel, from six to 
ten grains with as many grains of jalap, or by the 
cooling mixture, (see Appendix) a table-spoonful every 
three hours. Take diluting drinks, as lemonade or 
water, containing cream of tartar, barley-water, &c, 
avoid stimulating food or drinks. Evaporate spirits 
on the part by frequently applying it with a soft rag. 

As soon as the bowels have been moved, if the dis- 
ease continue to increase, it is recommended to give 
quinine two grains, every two hours, in a draught of 
water, till the inflammation and extent of the disease 
manifestly lessen. The room should be kept cool and 
dark, and the patient still. 



ITCH. 

One of the best medicines for this complaint is sul- 
phur, which should be used both externally and in- 
ternally. The parts most affected may be rubbed every 
night with ointment, made of flower of sulphur two 



120 DISEASES OF THE SKIN. 

ounces, and hog's lard or butter rubbed together ; 
chloride of lime, a table-spoonful, dissolved in a wine- 
glass of water, may be rubbed ovejf the pimples. As 
much flower of sulphur as is requisite to keep the 
bowels open, may be taken every night. It will be 
necessary to observe cleanliness, and after the disease 
is removed, to fumigate the clothes with sulphur, or to 
immerse them in water. 



NETTLE RASH. 



This resembles the eruption produced by the sting- 
ing of nettles ; there is itching, and the eruption comes 
and recedes with quickness ; rubbing or scratching 
brings it out. 

It is caused by swallowing cold drinks, or crudities, 
when heated, also by sour milk and rancid cheese, and 
by shell fish. 

The treatment may be simply magnesia, or a Ro- 
chelle powder, followed by a cup of tea without milk. 



PRICKLY HEAT. {Lichen Tropicus.) 

This is among the primary effects of a hot climate, 
and may be called one of the miseries of a tropical 
life, Avhich assails at all, and particularly the most un- 
seasonable hours. " Many a time (says Dr. Johnson) 
have I been forced to spring from the table and aban- 
don the repast, which I had scarcely touched, to writhe 
about in the open ah' for a quarter of an hour ; and 
often have I returned to the charge, with no better 
success, against my ignoble opponent ! The night 
affords no asylum. For some weeks, after arriving in 
India, I seldom could obtain more than an hour's sleep 
at one time, before I was compelled to quit my couch 



WOUNDS. 121 

with no small precipitation, and, if there were any 
water at hand, to sluice it over me for the purpose of 
allaying the inexpressible irritation ! But this was 
productive of temporary relief only, a more violent 
paroxysm frequently succeeded." It may be entirely 
absent while we are sitting still, but appears on the least 
exercise, or on taking any thing hot or stimulating. 

The only means, says Doctor Johnson, which I ever 
saw productive of any good effect in mitigating its 
violence, till the constitution got acclimated, were light 
clothing, temperance in eating and drinking, rest in the 
heat of the day, open bowels, and last, not least, a 
determined resolution to resist, with stoical apathy, its 
first attacks, by which the enemy will generally sneak 
off, and leave us victorious for the time. 



WOUNDS. 



As an enumeration of the many classes, into which 
wounds are divided by surgical writers, would confuse 
those for whom this book is intended, they are here 
included in three divisions, viz., Incised wounds, or 
simple cuts, made with a sharp instrument ; Contused 
wounds, or bruises, including gunshot and lacerated 
wounds ; Punctured wounds, or those produced by a 
sharp pointed instrument, as a nail or dirk. 



INCISED WOUNDS, OR CUTS. 

The first object of attention in cuts, is to stop the 
bleeding. In wounds of the limbs, where the bleeding 
is alarming, a tourniquet or bandage is to be applied 
above the part in the following manner : a strip of can- 
vass or strong cloth, an inch and a half wide and two 
yards long, is to be passed twice round the limb, the 
best place being about the middle of the arm or thigh, 
10* 



122 WOUNDS. 

and tied in a hard knot ; introduce between the turns 
of the bandage a stick three or four inches long, and 
turn it like a screw, till the twisting of the bandage 
arrests the flow of blood. A strong pocket handker- 
chief, passed twice round the limb and tied in a hard 
knot may answer the same purpose. 1 

We then wash and cleanse the wound, in order to 
ascertain where the bleeding orifice of the vessel is. 
It may be necessary, for this, to slacken the tourniquet, 
so as to make the blood flow again ; then, screwing it 
again, take up the artery, if there are suitable instru- 
ments on board — if not, try the following : take a sew- 
ing needle and insert the eye into a handle, like an 
awl, hold the point of the needle in the flame of a 
candle till it is red-hot, then cool it slowly, which will 
take out the temper of it, so that it can be bent into a 
fine hook ; with this transfix the end of the bleeding 
vessel, and hook it out, so as to admit of a thread be- 
ing put round it and tied. This is the most effectual 
w r ay of stopping blood, if the vessel be large ; and 
which I have, in the absence of the proper instrument, 
more than once used with success. The next surest 
way will be, to take a large wire, or even a common 
board nail, and heating it, sear the vessel. If the artery 
be very small, cobwebs or scrapings of sole-leather, or 
sponge or flour, may be pressed against the bleeding 
vessel, and pressure applied with a bandage. 

The wound is then to be dressed by bringing its 
edges accurately together, and confining them with 
slips of adhesive plaster three or four inches long, laid 
across the cut. A narrow slip of lint or rag, spread 
with simple ointment, is to be laid over the wound on 
the adhesive plaster ; lint or tow then applied to absorb 
the discharge, and, lastly, a bandage rolled on to confine 
the dressings. An assistant is then to make pressure 

1 The author has the satisfaction of learning, that the New Bedford 
and Nantuket whalers, in most cases, have in their medicine chests a 
first-rate tourniquet. This fact, with many others, speaks well for 
the liberality of their owners. 



WOUNDS. 123 

on the wound, while the tourniquet is gently slackened. 
The tourniquet is, however, to be continued loosely 
round the limb, ready for use, in the event of a return 
of bleeding. The dressings may be renewed in three 
or four days, excepting the adhesive plaster, which 
should be continued till adhesion of the wound has 
takeri place, or for six or seven days. 

It will be advisable to move the bowels with a mild 
cathartic, as cream of tartar, and to subsist on a light, 
unstimulating diet. 

If an artery is wounded where no tourniquet can be 
applied, the bleeding must be stopped by filling the 
wound with bits of sponge or dry lint, and applying 
pressure ; the lint or sponge not to be removed till it 
suppurates and can easily be taken out. If the bleed- 
ing artery can be taken up and tied, it should be done ; 
and if not, the bleeding orifice may be seared with a 
large wire heated. 

In slight cuts, a tourniquet will not be required. In 
other respects the above treatment should be adopted. 
If the wound gapes open a stitch may be taken in it. 



Contusions or Bruises, and Lacerations, as well 
as Gunshot Wounds, are more painful than incised 
ones ; are swelled, ragged, and not attended with much 
bleeding. 

The principal objects in the treatment, are to mod- 
erate inflammation, and to accelerate the healing pro- 
cess. The first is to be effected by warm poultices 
made of Indian meal and flax-seed, or pounded biscuit 
and flour boiled together, applied every three or four 
hours, and by bathing the part in warm water. When 
inflammation has abated, the healing of the wound 
may be promoted by dressing it with lint, spread with 
basilicon. 

If the form of the wound will admit of its edges being 
drawn towards each other, their approximation should 
be supported by adhesive plasters and bandages. 



124 BURNS AND SCALDS. 

If the wound be attended with great swelling and 
pain, the patient must be bled and purged, in propor- 
tion to the violence of these symptoms, and stimulants 
of every kind avoided. A few drops of laudanum 
may afford relief. 



Punctured wounds are frequently produced by 
nails or sail needles, and stabs are sometimes made by 
knives or dirks. The consequences may be lock-jaw 
or extensive abscesses. 

The most effectual way of preventing these evils is 
to enlarge the opening with a lancet or sharp knife, 
and thus convert the puncture into a simple cut, which 
is to be dressed accordingly. When this is not done, 
the part should be kept still, and dressed frequently 
with warm poultices. If the wound be deep and un- 
attended with much bleeding, there will be danger of 
violent inflammation, that may require bleeding and 
purging to subdue it. 



BURNS AND SCALDS. 

The part should be immersed in cold water or other 
cold fluid immediately, and continue there till some 
raw cotton is brought, and ready for application to the 
burn. This article will allay the inflammation, and if 
seasonably used, will even prevent the formation of 
blisters. It may be renewed every twelve hours, care 
being taken to preserve the skin from injury. If the 
pain be excessive, give a grain of opium every half 
hour, till it is alleviated. If no cotton can be had, 
continue cold applications and apply a poultice made 
of scraped raw potatoes. Should the burn be very 
severe and extensive, it may be necessary to adminis- 
ter gentle laxatives and to abstain from stimulants. 

Should the burn be deep, apply soft poultices made 
of Indian meal or pounded bread and flax-seed, or 



CHILBLAINS. 125 

flour, and after the inflammation has abated, the heal- 
ing of the ulcer may be promoted, by dressings of 
simple ointment, made of spermaceti, olive, or sperm 
oil and beeswax, equal parts, spread on soft lint, over 
which a bandage may be applied moderately tight. 
When fungus or proud flesh appears, it may be 
touched with blue stone. The blisters occasioned by 
burns should not be opened immediately, as the ac- 
cess of air will cause deep ulcers. After a day or 
two, they may be punctured with a lancet, or needle, 
and the skin suffered to remain on. 

A liniment made of lime water and oil shaken to- 
gether, and applied, with a feather or soft rag, to ulcers 
from burns will be useful. A cooling ointment for 
burns, may be made by melting together sperm or 
olive oil, beeswax, and spermaceti — and while liquid 
add half the quantity of lead water, made by dissolv- 
ing 4 or 5 grains of sugar of lead in a wine glass of 
water, and stirring it into the ointment whilst it is 
cooling. 



CHILBLAINS, OR FROST-BITES. 

When the extreme parts of the body are exposed 
to severe cold, they are first affected with numbness, 
and afterwards with swelling and inflammation, and 
sometimes mortification. 

Immediately on perceiving the numbness, the pa- 
tient should immerse the part in cold water, or rub it 
in snow, and on no account approach the fire, till its 
feeling is restored. He should also abstain from stim- 
ulants and warm drinks. 

When these precautions have been neglected, and 
a high degree of inflammation has ensued, the part 
should be dressed, at first with cold and afterwards 
with warm poultices, till the inflammation is subdued, 
when the ulcers may be dressed with some mild oint- 
ment, 



126 ULCERS, ETC. 



ULCERS. 



These may be occasioned by wounds, bruises, burns, 
frost, &c. Where there is a tendency to scurvy, even 
the scratch of a pin may produce an ulcer of great 
malignancy. Old sailors, whose constitutions are 
much impaired by intemperance, are often afflicted 
with obstinate ulcers on the shin. The longer such 
sores continue, the greater will be the length of time 
necessary to heal them. 

Recent and healing ulcers should be washed daily, 
and dressed with mild ointments applied on lint ; all 
sources of irritation should be. avoided ; the part kept 
still and in a horizontal posture. If the ulcer be of 
long standing and slow in healing, the edges of it may 
be drawn towards each other, by means of straps of 
adhesive plaster. If the ulcer be on the leg, a band- 
age should be applied over the adhesive straps from 
the foot to the knee, with as much firmness as the pa- 
tient can bear. The edges of the ulcer should be oc- 
casionally touched with blue stone. If a high degree 
of inflammation and swelling be induced in an ulcer 
by cold or other causes, it should be bathed with warm 
w r ater, and poulticed frequently. 



BITES OF THE VIPER, SNAKES, ADDERS, &c. 

The symptoms that usually follow are a swelling of 
the part, faintness, giddiness, vomiting, difficulty of 
breathing, cold sweats, convulsions, and sometimes 
death. 

The most effectual way of obviating these symp- 
toms, is the immediate cutting out of the part or 
burning it with fire. Where this is not done salt may 
be applied to the part and the wound sucked for a 
long time, the mouth being defended by oil. A tight 
ligature should at the same time be kept on the limb, 



GUINEA WORM, ETC. 127 



above and near the wound. It is recommended by 
some to apply hot spirits of turpentine to the part. 
The Indians burn gunpowder on the part bitten. 

In the south of France the bite of the scorpion is not 
dangerous, rarely worse than the sting of a wasp. In 
tropical climates it is much more deadly, and is to be 
treated like viper bites. The viper bite is often at- 
tended with danger, especially in the summer, and 
when the reptile is strong and enraged. 



GUINEA WORM. 



In Guinea and in some parts of the East and West 
Indies, foreigners, as well as inhabitants, are often 
troubled with the Guinea Worm, which the celebrated 
Dr. Lind thus describes ; " This is a white, round, 
slender worm, often some yards long, lodged in the 
interstices of the muscles, commonly in the legs, feet, 
or hands ; when it attempts to escape through the 
skin, it occasions a swelling, resembling a boil, at- 
tended with great pain, until its little black head ap- 
pears in a small watery bladder, on the head of the 
boil. When this bladder breaks, the head of the 
worm is to be secured by tying it to a small roll of 
linen, spread with plaster ; and part of the worm is 
once or twice a day to be drawn forth, with care not 
to break it, and wrapped round this roll, until it be 
brought away entire ; then the ulcer heals soon ; but 
if part of the worm breaks off, the portion remaining 
in the flesh can be extracted only by painful and te- 
dious suppurations in different places. 55 



OF PERSONS APPARENTLY DROWNED. 

When the body is taken out of the water, it is to be 
stripped as soon as possible, wiped perfectly dry, and 



128 POISONS SWALLOWED. 

then laid between two blankets. The head is to be 
covered with warm flannels, hot substances applied to 
the feet, belly, and breast, and the body constantly 
rubbed with the hands. 

The lungs are to be inflated as soon as possible with 
a pah* of bellows, by inserting the pipe in one nostril, 
while the other nostril and mouth are kept closed, and 
blowing forcibly. When the breast is swelled by it, 
the bellows should stop, and an assistant should press 
the belly upwards to force the air out. This process 
should be repeated, twenty or thirty times in a minute, 
so as to imitate natural breathing as nearly as possible. 
If a bellows cannot be procured, some person should 
blow into one of the nostrils through a pipe or quill, 
whilst the other nostril and mouth are closed as before. 
During this time a large quantity of ashes, or water, 
should be heated, and as soon as it is milk warm, the 
body placed in it ; the blowing and rubbing continued 
as before, and, when the ashes or water are cooled, 
more is to be added, so that the whole may be kept 
blood- warm. AVhen signs of returning life are appa- 
rent, the frictions must be continued, but more gently. 
These methods are to be continued three or four hours. 
When the patient can swallow, he is to take some 
warm spirits. 



POISONS SWALLOWED. 

When laudanum, opium, or morphine, or other 
poisonous vegetable substance is swallowed, a stomach 
pump should be used immediately, by which fluids may 
be pumped into and out of the stomach. In case a 
pump is not to be had, the stomach should be excited 
without delay by emetics, to throw off its contents, 
such as white vitriol, or blue vitriol, fifteen to twenty 
grains, or about a tea-spoonful dissolved in half a 
tumbler of water, and assisted by passing a finger or 



OPERATIONS. 129 

feather down the throat, swallowing warm water, and 
if necessary, repeating the emetic. He should not be 
allowed to sleep, but kept constantly in motion, have 
the head dashed with cold water, and the whole surface 
rubbed and stimulated with small rods or twigs. After 
the first effect of the poison has subsided, give a dose 
of Epsom. 

If mineral or other poisonous acids have been swal- 
lowed, give magnesia, or soda, or salseratus dissolved 
in water ; or if these cannot be had, shake a piece of 
hard or shaving soap in water, and give the water to 
drink, afterwards thin gruel, rice water, or starch. 

If arsenic or corrosive sublimate has been swallowed, 
beat up the whites of half a dozen eggs in water, and 
give them, or starch made of a similar consistence ; 
milk with wheat Horn' stirred in it, will be useful. A 
medicine called the hydrated peroxyde of iron is a 
known antidote to arsenic, but this cannot be obtained 
on board a ship, nor is arsenic likely to be taken there. 

Poisonous Fish are often taken, especially on the 
shores of South America. The usual symptoms are 
irritability of the skin, swollen eyelids, difficult breath- 
ing, and convulsions. 

The treatment consists in emetics of ipecac, or white 
vitriol, followed by castor oil. 



OPERATIONS. 

BLOOD-LETTING FROM THE ARM. 

The operator and patient being placed in proper re- 
lative situations, which it will be needless to describe, 
a ligature or narrow bandage is to be passed round the 
arm, just above the elbow, so as to compress the vein 
about two inches above the part from which the blood 
is to be drawn ; and having been suffered to remain 
some minutes, in order for the vein to become distend- 
11 



130 OPERATIONS. 

ed, the thumb of the left hand should be pressed upon 
the vein made choice of, about two inches below the 
point where the orifice is to be made. The operator 
is now to take the lancet, previously bent nearly to a 
right angle, between the finger and thumb of the right 
hand, leaving at least half the blade uncovered. He 
is then to rest his hand on the three remaining fingers, 
while he pushes the point of the instrument cautiously 
through the integuments into the vein ; when, having 
thus pierced its coats, he is to carry it forwards in a 
direction rather obliquely, until an orifice of sufficient 
size is made. 

When a sufficient quantity of blood has been drawn, 
the ligature is to be untied, and the lips of the wound 
being carefully brought together, a small piece of fold- 
ed linen is to be applied upon the orifice, and secured 
in that situation by a roller, passed alternately above 
and below the elbow, so that when applied it may de- 
scribe the figure oo by crossing at the bend of the arm. 

Faintness, which sometimes occurs during bleeding, 
may be removed, by a draft of cold water, or by taking 
a horizontal position. 

If the blood runs slowly, immerse the hand in very 
warm water. The ligature applied above should not 
press so hard as to stop the pulse. 

Every direction given for blood-letting in the arm, 
is applicable to the foot, the bandage to be placed an 
inch or two above the ankle. 



OF THE APPLICATION OF LEECHES. 

The manner of applying these is too well known to 
require a description. Success is rendered more cer- 
tain, by previously drying them, or allowing them to 
creep over a dry cloth ; the part also, to attract them, 
may be moistened with cream, sugar, or blood, or 
punctured with a needle. 



OPERATIONS. 131 



OPENING A TUMOR OR ABSCESS. 

The opening should be made in the most prominent 
part, and if it be on a limb, the incision is to be made 
lengthwise, and not across the limb. The part should 
be covered with plaster to exclude air. 



AMPUTATION. 



As accidents sometimes happen at sea, in situations 
where it is impossible to obtain a surgeon, and which 
require the immediate amputation of a limb, it is pro- 
per to say a few words on that subject. To perform 
the operation is one thing, to know when it ought to 
be performed is another. Any man of common dex- 
terity and firmness, can cut off a leg, but to decide 
upon the necessity of doing so, requires much judg- 
ment; instances having occurred where, under the 
most seemingly desperate circumstances, the patient 
has through fear or obstinacy, refused to submit to the 
knife, and yet afterwards recovered. 

Although in many cases much doubt may exist, in 
determining whether it is proper to amputate or not, 
yet in others all difficulty vanishes, as when a ball has 
carried away an arm. Suppose for a moment, while 
rolling in a heavy sea, during a gale, the lashings of a 
gun give away, by which a man has his knee, leg, or 
ankle completely mashed, or either of these parts is 
crushed by a fall from a topgallant yard. The great 
laceration of blood vessels, nerves, and tendons, and 
the crushing and splintering of the bones, almost 
necessarily resulting from such accidents, render im- 
mediate amputation an unavoidable and imperious 
duty. 

If there are none of the regular instruments on 
hand, you must provide the following, which are 
always to be had. 



132 OPERATIONS. 

A razor, opened straight, and made fast at the joint 
with twine ; a carpenter's tenon saw ; a darning-needle 
inserted into a handle like an awl, one third of it to- 
wards the point to be heated red in the blaze of a 
candle, and suffered to cool very slowly so as to draw 
out the temper, and then bent like an awl ; in the 
place of a tourniquet, a handkerchief and stick ; a 
piece of cotton or leather, five inches wide and twenty 
long, slit up the middle to half its length ; a dozen 
ligatures, each a foot long, made of waxed thread, 
bobbin, or fine twine, several narrow strips of sticking 
plaster ; dry lint ; a piece of linen large enough to 
cover the edge of the stump, spread with simple oint- 
ment, or lard ; a bandage 3 or 4 yards long, the width 
of the hand, sponges aud warm water. 

AMPUTATION OF THE ARM. 

Give the patient 60 drops of laudanum, and seat 
him on a narrow and firm table, of a convenient 
height, so that some one can support him by clasping 
him round the body. Place the handkerchief and 
stick as high up on the arm as possible, (the stick be- 
ing very short) and so that the knot may pass on the 
inner third of it. Your instruments having been re- 
gularly placed on a table or waiter, within reach of 
your hand, while some one supports the lower end of 
the arm, take the razor and make one straight cut all 
round the limb, through the skin and fat only ; then 
cut these up from the flesh one inch higher, let the as- 
sistant hold them back, while you cut through the 
flesh at one sweep, down to the bone. The assistant 
next puts on the slit piece of linen astride the bone, 
and pulls back the flesh from the bone, while you saw 
as high up as possible without wounding the flesh. 
With the curved needle or pincers, you then seize and 
tie up every vessel that bleeds, the larger ones first ; 
when this is done, relax the stick a little, if an artery 
springs, tie it as before. The wound should now be 
gently cleansed with a sponge and warm water, and 



OPERATIONS. 133 

the stick be relaxed. If the arteries are evidently all 
tied, bring the flap of skin over the end of the stump, 
draw its edges together with long strips of sticking 
plaster, leaving the ligatures hanging out at the angles, 
lay the piece of linen spread with ointment over the 
strips, a pledget of lint over that, and secure the 
whole by the bandage, when the patient may be car- 
ried to bed, and the stump laid on a pillow. 

The handkerchief and stick, are to be left loosely 
round the limb, so that if any bleeding happens to 
come on, it may be immediately tightened by the per- 
son who is watching by the patient, when the dres- 
sings are to be taken off, the flap raised, and the 
vessel sought for and taken up, when every thing is to 
be placed as before. 

In sawing through the bone, a long and free stroke 
should be used to prevent any hitching, as an addi- 
tional security against which, the teeth of the saw 
should be well sharpened and set wide. 

The most painful part of the operation, will be the 
first incision through the skin ; the sawing gives no 
pain. 

If by any means, there is a difficulty in applying a 
ligature round the artery, pass the crooked needle 
with a strong thread round the end of it, and tie it ; 
the less of fleshy substance included in the thread, 
with the artery, the better. 

The bandage that is put round the stump, should be 
rolled round from above, downwards, so as to support 
the fleshy part, and the straps of plaster that hold the 
flaps together, in order that the skin of the two oppo- 
site sides of the stump may be preserved in exact 
contact. These bandages should not be disturbed for 
four or five days, by which time there is reason to 
hope that the stump has formed a firm adhesion. In 
changing them, they should be well soaked with warm 
water, then plasters, lint, and bandages are to be 
applied, and changed again every two days. In ten, 
days the ligatures may be drawn away. 
11* 



134 OPERATIONS. 

Amputation of the thigh is performed in the same 
manner, as that of the arm. 

In amputating the fore-arm, and leg, in which 
there are two bones, a sharp penknife will be wanted 
to divide the flesh between the bones, after having 
made the circular incision with a razor, down to the 
bones. The slip of cotton or leather, that is to serve 
for a retractor of the flesh during the sawing, should 
be divided at one end into three instead of two slips, 
and the middle slip is to be passed between the bones, 
which with the other two will hold the flesh back out 
of the way of the saw. In other respects, the opera- 
tion should be performed as in the arm, already de- 
scribed. 



Amputation of fingers and toes, will require a 
penknife. Draw the skin back and make an incision 
round the finger, a little below the joint it is intended 
to remove ; turn back a little flap to cover the stump, 
then cut down to the joint, bending it so that you can 
cut through the ligaments that connect the two bones, 
the under one first. The head of the bone is then to 
be turned out, while you cut through the remaining 
soft parts. If you see an artery spirt, tie it, especially 
in the great toe, but generally it will soon stop bleed- 
ing of itself. Bring down the flap and secure it by a 
sticking plaster, and a narrow bandage over the 
whole. 



INTRODUCTION OF THE BOUGIE. 

The patient may either stand or lie ; a middle-sized 
bougie is to be well covered with olive oil, and the 
penis taken in the left hand ; the point of the instru- 
ment should then be very cautiously introduced into 
the urinary passage ; when it meets with obstruction, 
it must be gently moved backwards and forwards 



OPERATIONS. 135 

several times. If unsuccessful, the bougie is to be 
withdrawn, and after an hour or two a smaller one 
tried. In some cases a middle-sized bougie will pass, 
when a smaller one cannot, and therefore that size 
should be always tried first. If introduced for a stric- 
ture^ it should be repeated morning and evening, and 
remain from a quarter of an hour to an hour. 



INTRODUCTION OF A CATHETER. 

In introducing the catheter, the patient may He with 
his head and knees raised. The catheter must be well 
covered with olive oil, and the penis held in the left 
hand, while the point of the instrument is cautiously 
introduced into the urinary passage, gently moving it 
backwards and forwards, till it enters the bladder, 
which may be ascertained by its having overcome all 
resistance ; then the wire inclosed in the catheter be- 
ing drawn out, the urine will flow off, when the instru- 
ment may be withdrawn. 



CLYSTERS, HOW TO BE ADMINISTERED. 

These may be administered with a pipe or tube, in- 
serted into the neck of a bladder ; or a syringe, an 
instrument, with which every medicine chest should 
be supplied. The fluid to be injected, being intro- 
duced into the bladder, through an opening made in 
the side, which is to be tied up with a piece of twine, 
the pipe is to be well oiled, when the patient himself 
may introduce it into the fundament. He should then 
hold his breath, while the bladder is gradually pressed 
from the top to the tube, till all the liquid is injected. 
The point of the pipe, should be directed backward 
a little, rather than in the hue of the body. Every 
medicine chest should be supplied with a pewter 
syringe. 



DIRECTIONS 



FOR PRESERVING THE HEALTH OF SEAMEN AND PASSENGERS, IN 
MERCHANT VESSELS, IN SICKLY CLIMATES. 



PRELIMINARY REMARKS. 

The foregoing pages contain some brief instructions 
for the treatment of diseases, when they have actually 
appeared on ship-board. A long sea service has, how- 
ever, convinced me, that on board merchant vessels, 
prevention is more important than cure. In vessels 
exclusively devoted to the purposes of commerce, the 
necessities of the sick can hardly be looked for. In 
long voyages especially, in which it is important that 
the ship be as perfectly filled with cargo as possible, 
little room can be spared for the accommodation even 
of healthy seamen. When disease occurs during such 
voyages, it is peculiarly distressing. Conveniences 
are unprovided — attendants cannot be spared from 
the crew — and the patient is liable to error in the 
selection of his remedies. But if there be any marine 
service in which the occurrence of disease may be in 
the surest manner prevented, it is in the merchant ser- 
vice of this country. In the first place, voyages in 
general are performed in a length of time, which can 
be tolerably well calculated on ; the means necessary 
for the prevention of diseases can therefore be accu- 
rately estimated, and most of them are of such a na- 
ture, that, if not necessary for one voyage, they will 
be in readiness for another. 

In the next place, the nautical skill of our seamen 
is such, that a few men only are found necessary to 
take every care of large vessels. This very circum- 



REMARKS. 137 

stance is of great consequence, in the prevention of 
disease ; for as a general rule, prevention is easy in 
proportion to the fewness of the individuals, among 
whom it is to be attempted. The exception will be, 
in those voyages in which from unusual circumstances 
the duty of men is very constant and severe. The 
unusual circumstances alluded to, are storms in lati- 
tudes and seasons, which are ordinarily temperate — 
the employment of old vessels for long and fatiguing 
voyages, in which the labor of pumping, &c, is almost 
incessant — and voyages so calculated, that the Ameri- 
can coast shall be made in the winter or early spring 
season, when the exposure of the men is necessarily 
very great, and endured under circumstances ex- 
tremely favorable to the production of disease, viz. 
the return from a long voyage with perhaps a short 
allowance of provisions, and almost certainly with a 
very scanty supply of clothing. Except the concur- 
rence of many, or all these circumstances, which in- 
deed is very rare, prevention, as was observed, will 
be most certain among small crews. 

Furthermore, men are more regularly employed. 
Indolence, therefore, which is among the predisposing 
causes of nautical disease, is not a habit of the crew. 
The men can be kept cleaner, for their habits can be 
more easily observed. Their berths are more easily 
cleansed and their apartments ventilated. Finally, the 
means of prevention which are to be found in diet, 
can with greater certainty, because with less expense, 
be provided. Those articles which are not usually 
employed except during disease, may be more readily 
and willingly laid hi, and the attention of officers more 
certainly directed to the use of preventive and cura- 
tive methods. In all this, the seaman has principally 
been regarded. But the owner is not altogether with- 
out interest in the discussion. It is of importance to 
him, if his crew be small, that their health be pre- 
served. The loss of a man, with the sickness of three 
or four, may frustrate the best concerted voyage. 



138 DIRECTIONS. 

These considerations alone, are sufficient to establish 
the truth of the importance of preventing disease on 
board merchant vessels. 

It may be further added, that the means of preven- 
tion are readily understood and easily applied. It is 
of no consequence that the commander is not a medical 
man ; for if he, his owners, and his crew perform their 
various obligations to each other, disease at sea must 
be of rare occurrence. What these obligations are, 
may, hi some measure, be gathered from the following 
pages. In offering them I have to acknowledge my- 
self indebted, for many useful suggestions, to the writ- 
ings of Drs. Lind, Turnbull, and Sir Gilbert Blane. 

Directions, 8fc. 

The only very fatal diseases incident to seamen are 
fevers, fluxes, and scurvy, in hot climates ; and pulmo- 
nary affections and scurvy, in cold climates. If I were 
to add any other complaint, says Dr. Blane, to those 
just mentioned, as most prevalent, and peculiar to a 
sea-life, it would be those foul and incurable ulcers, 
which are so apt to arise at sea, particularly in a hot 
climate. The slightest scratch, or the smallest pimple, 
more especially on the lower extremities, is apt to 
spread, and to become an incurable ulcer, so as to end 
in the loss of a limb. The nature of the diet and the 
malignant influence of the climate, both conspire in pro- 
ducing them. 

The distinguishing characteristics, causes, and treat- 
ment of these diseases, are given m the former part of 
this work; the object, more immediately before us, is 
to prevent them. The records of nautical medicine 
furnish abundant evidence, that if proper precautions 
are taken in manning-, victualling' and governing a ship, 
the diseases, which may, in some measure, be consid- 
ered as peculiar to a sea-life, would be unknown. The 
subject is, therefore, addressed alike to captains, own- 
ers, and crews. 

It has been remarked, that the prevention of diseases 



AIR OF TROPICAL CLIMATES. 139 

has relation only to external causes that affect health ; 
and some of these will now be considered under the 
three heads of 

1. Air. — 2. Aliment. — 3. Clothing. 



AIR. 

1. On the air of tropical climates, as a cause of disease 
among seamen. 

In treating on air, as a cause of nautical diseases, it 
will be considered under two general heads, viz., as 
constituting climate, and as the peculiar atmosphere of 
the internal parts of ships. Over the first we have no 
control. The hot and oppressive atmosphere of the 
healthiest West India stations, and the deleterious 
effluvia from morasses and marshes of the unhealthy 
ones, are equally uncontrollable. Whether these, 
however, shall act as causes of disease on ship-board, 
depends very much on crews, but still more on their 
commanders. The state of the air at sea is likewise 
beyond control. It may be damp, wet, and cold, and 
the demand for almost perpetual exertions on the part 
of the seamen be too imperious, to be evaded, under 
the wish to preserve the health of the crew. But even 
under these circumstances disease is not a necessary 
occurrence. Means may be, and are occasionally 
adopted, which result in a remarkable exemption from 
disease, where to escape seemed impossible. 

As far as climate is concerned, or may become a 
cause of disease, nothing is more obvious, in inquiring 
into the means of prevention, than the importance of 
removing men as far as possible from its influence. 
The methods by which this may be effected are not 
quite as evident as the importance of the rule. Some 
of these methods will now be stated. Experience has 
abundantly established the fact, that, except the scurvy, 
all the diseases incident to vessels are more apt to arise 



140 DIRECTIONS. 

in a harbor than at sea, and particularly the destructive 
fevers, peculiar to hot climates. While riding at anchor 
in a harbor, situated in such climates, the habits of sea- 
men are necessarily, in some measure, altered. The 
regularity of sea-duty is broken in upon, a sudden and 
great change is made in the diet, a temperature very 
different from the coolness of sea-air is endured. The 
harbor may have in its neighborhood, or on its very 
shores, extensive marshes, from which the heat of the 
sun is constantly raising deleterious effluvia. The sun 
is at times pouring an intense heat on the men while 
at work, and their duty often calls them on. shore, for 
the purposes of wooding and watering. In such cli- 
mates, more particularly in the West Indies, spirituous 
liquors and unwholesome fruits are generally easily 
obtained, and at times the men, from eluding the vigi- 
lance of their officers, sleep in a state of intoxication 
on the ground on shore. There is also in such climates 
sudden changes, from excessive heat to cold or cooler 
air, and generally at night a cold damp air is experi- 
enced. There is something so refreshing in this change 
that the chances of diseases are frequently willingly 
run, rather than submit to a caution which seems to 
require too great a sacrifice of personal comfort. The 
evils, however, which would seem to be the necessary 
consequences of circumstances, just enumerated, may 
be avoided, and the diseases, of which they seem al- 
most necessary causes, may be prevented. "I have 
known," says Sir Gilbert Blane, " a hundred yards in 
a road make a difference in the health of a ship at an- 
chor, by her being under the lee of marshes in one sit- 
uation, and not in the other. Where people at land are 
so situated as not to be exposed to the air of ivoods and 
marshes, but only to the sea-air, they are equally healthy 
as at sea. There was a remarkable instance of this on 
a small island, called Pigeon island, where forty men 
were employed in making a battery, and they were 
there from June to December, which includes the most 
unhealthy time of the year, without a man dying, and 



AIR OF TROPICAL CLIMATES. 141 

with very little sickness among them, though they 
worked hard, lived on salt provisions, and had their 
habitations entirely destroyed by the hurricane. Dur- 
ing this time near one half of the garrison of St. Lucia 
died, though in circumstances similar in every respect, 
except the air of the place, which blew from woods 
and marshes." Facts, similar to these, are to be found 
scattered through all the books which have been writ- 
ten for the preservation of the health of seamen. The 
practical advantages to be derived from them are plain 
and obvious to the most common understanding. Dis- 
eases of a fatal nature, occurring in a climate and 
harbor, such as has now been alluded to,, are to be 
checked, where it is possible, by altering the anchorage ; 
and it appears that in some instances a very small al- 
teration will be found quite sufficient. If circumstances 
prevent this, other means of prevention must be re- 
sorted to. 

It is a well known fact, that in the climates alluded 
to, the winds, after the first hours of the morning, blow 
from the sea towards the land, and that the land 
breeze, or the breeze off shore, takes place in the 
evening, and continues during the night. During the 
day, therefore, the sailor is in little danger of disease 
from the effluvia from shore. He is chiefly to be on 
his guard against the night air. He will best do this 
by carefully avoiding to sleep on deck ; and by atten- 
tion to his clothing. Other means of great impor- 
tance, are those medicinal articles, which are known 
to give and preserve the tone of the system, and which 
experience has satisfied us, will protect men against 
fevers. Such are the Peruvian bark, and other bitters, 
the capsicum, and other spices, common to the 
climates under consideration. In those seasons, there- 
fore, which are known to be unhealthy, these means 
should be early resorted to, and the consequences will 
in general, be the safety of those who must be in some 
degree, exposed to the influence of the causes of 
disease, 

12 



142 DIRECTIONS. 

Having now stated the methods by which the health 
of seamen, may be preserved in situations which ex- 
pose them to the influence of noxious effluvia from 
morasses, and marshes, I shall in the next place speak 
of the sensible qualities of the ah' of hot climates, in 
then connections with disease. 

" If I were required," says Blane, " to fix on a cir- 
cumstance, the most pernicious of all others to Euro- 
peans, particularly those newly arrived in the West 
Indies, I would say, that it is exercise in the sun." 
The same remark is repeatedly made by Johnson, on 
the climate of India, Batavia, Java, and the southern 
coast of China. Heat is not only by itself a very 
powerful cause of febrile diseases, but the exhaustion, 
which it induces in laboring men, exposes them 
strongly to the temptation of the excessive use of 
spirituous liquors, which, next to heat itself, is one 
of the most hurtful practices that can be indulged. 
Another excess, to which seamen are exposed in hot 
climates, is in .the use of the various fruits which are 
common to such climates. It is hardly possible to de- 
ter men from these practices, and then consequences 
frequently are, fevers and fluxes, of a very severe na- 
ture, and occasionally of a fatal issue. 

One of the principal means of diminishing the 
chances of disease, which may arise from the action 
of excessive heat, is to employ, as far as it is practi- 
cable, the natives of hot climates in the hard labor 
that may be required for the ship on shore. More es- 
pecially, let these men be employed to procure wood 
and water, should these be necessary on ship-board. 
Of all occupations, the most pernicious is that of 
clearing a foul hold, in tropical parts, and therefore 
ships requiring it, should be sent to a more northern 
and cooler port, and on no account employ the crew 
in such duties, where natives can be had. In seasons 
peculiarly unhealthy, let natives be also employed in 
getting the cargo on board. In this way, opportuni- 
ties for procuring spirituous liquors will be much 



AIR OF TROPICAL CLIMATES. 143 

diminished, men will more rarely be found exposed, 
while drunk, to the burning heat of the sun on shore. 
Fevers, which are among the most dangerous and 
fatal diseases of hot climates, will be less frequent. 
There is a peculiar improvidence, and want of all 
caution, to be observed in the character of sailors. 
The chances of disease and death are most willingly 
incurred, for they are never adverted to. It requires 
more than precepts on the part of officers, to keep the 
men out of the way of evil. The secret of preserv- 
ing health, under the exposures now under considera- 
tion, is to put the men as far as possible out of the 
influences of the causes of disease. If anchoring 
ground is occasionally to be changed, because the 
present one exposes a crew to the destructive air and 
morbid effluvia of a low putrid marsh, the officers of 
a ship in hot climates are, as far as practicable, to re- 
move men from all other causes of disease. 

But as wooding and watering in sickly climates are 
sometimes the unavoidable duties of crews, it may be 
expected that those who undertake them, should be 
furnished with some advice for their preservation. 

" I would advise," says Dr. Lind, " all who are 
employed in cutting down woods, or in other laborious 
and dangerous services in hot climates, during the 
heat of the day, to have their heads covered with a 
bladder dipt in vinegar, and to w^ash their mouths 
often with vinegar, never to swallow their spittle, but 
rather to chew a little rhubarb, or some other bitter, 
and spit it out frequently ; to stop then* nostrils with a 
small piece of linen, or tow, dipt in camphorated 
vinegar ; and to infuse some bark, garlic, and rhubarb 
in brandy, of which a dram is to be taken either by 
itself, or diluted with water, morning and evening. 

" In the evening, before sunset, they should leave 
off work, and not return to their labor in the morning, 
till the sun has dispersed the unwholesome dews and 
vapors. For their safety during the night, they should 
retire to a close hut, as the dews may penetrate a 



144 DIRECTIONS 

tent, and here, in the absence of the sun, a constant 
fire should be kept ; or if that be found impracticable, 
the apartment in which they lie should be well fumi- 
gated with gunpowder, as fire and smoke will afford 
them a most excellent defence against the noxious 
qualities of the night air. The smoking of tobacco 
in their huts, and chewing of garlic, and not sleeping 
on the ground, are circumstances which will also con- 
tribute to their preservation. 

" If, from a neglect of these precautions, the noc- 
turnal chill fog has made an impression on the body, 
a vomit should be immediately administered near a 
fire, and a plentiful sweat excited after it, which will 
often prevent fatal consequences. If any symptoms 
of a low fever still continue, as a headache, sickness 
of the stomach, chills, &c, a blister ought immedi- 
ately to be applied, as these complaints, though so 
slight as not to confine the patient to his bed, are de- 
ceitful, and often terminate in a fatal malignant fever. 
If this fever can be brought to intermit, let the bark 
be immediately taken, to the quantity of a quarter of 
an ounce, or more, in red wine, every two hours, and 
the patient quickly removed into a better air." 

When a vessel arrives at a port, in the latitudes now 
under consideration, whether the voyage have been 
long or short, the men should be instructed not to in- 
dulge freely in the various fruits peculiar to such cli- 
mates. The exception to this rule, will be found in 
those cases in which scurvy exists in the vessel. They 
are more especially to avoid the free use of spirituous 
liquors. They should avoid all unnecessary exposure 
to the night air, particularly sleeping uncovered on 
deck, after the fatigues of the day. They should 
never sleep on shore, and as far as their duty permits, 
be as little exposed as possible, during unhealthy sea- 
sons, to the excessive heat of a tropical sun. These 
methods of prevention are extremely simple. They 
can be very easily adopted, and their objects to the 
merchant service, I again repeat, are extremely im- 



FOR PREVENTION OF CONTAGIOUS DISEASES. 145 

portant. Suppose for a moment, that a large propor- 
tion of a small crew is swept off, by the diseases of a 
hot climate ; new men must be shipped, a most diffi- 
cult, and expensive alternative ; the vessel must be 
delayed in port ; all the incidental expenses necessa- 
rily increased, and very frequently the principal ob- 
jects of commercial enterprise defeated. 

Notwithstanding, however, the use of such means 
of prevention, as circumstances admit of, should the 
febrile diseases of hot climates occur, how are they 
to be known ; and how are they to be treated ? It 
would be useless to enter on a detail of the symptoms 
of such diseases ; they are most generally recognized 
at a very early stage of them, by the captain, or the 
crew themselves, and their violence, rapidity, and fre- 
quently fatal termination, very soon discover their true 
character. If the disease occur in port, recourse 
should at once be had to a physician of the place. 
When a physician cannot be obtained, lose no time 
in applying the remedies laid down in the former part 
of this work. If notwithstanding the treatment, one 
or more cases should prove fatal, means should be at 
once adopted, to prevent the propagation of the disease 
among the crew, by infection. This may be attempted 
in the following manner. 

Means to prevent the spreading of contagious or infec- 
tious diseases in a ship. 

1. Let the sick be separated from the healthy ; and 
thus attempt to prevent its progress, by cutting off all 
intercourse with each other. 

2. Articles of clothing, bedding, &c, have been 
considered as dangerous vehicles of infection, as the 
persons of men. " It should be made a strict and in- 
variable rule, that in case of death from fever and 
flux, every article of the description mentioned, be 
thrown overboard with the bodies of those dead of 
these diseases.' 5 

3. Should the sick recover, as they might not be 

12* 



146 DIRECTIONS. 

able to spare these articles of clothing, &c, they should 
be smoked, and then scrubbed and washed, before the 
men join their messes, and return to duty. In ships 
of war and transports, this direction should be most 
carefully observed, " because their hammocks will fre- 
quently be brought in contact with those of the other 
men, by being stowed with them in the netting." 

4. As infection sometimes adheres to the timbers of 
a ship for a long time, such cause of disease should be 
thoroughly eradicated as soon as the disease itself dis- 
appears. This can only be effectually accomplished 
by fumigation. For this purpose, pots of charcoal 
and sulphur may burn between decks, after having 
carefully shut the hatches. Dr. Blane remarks, that 
an action with an enemy has been known to purge a 
ship from infection. Fires should be more frequent 
between decks during the prevalence of infection. 
The decks, beams, &c, should be washed and 
sprinkled with hot vinegar. The fume of pitch, tar, 
and other resinous substances, has a more powerful 
effect than any other smoke ; and besides what is 
thrown upon the fires, it would be useful to throw 
pitch upon a red hot iron, or to immerse a loggerhead 
in a vessel where there is pitch or tar. 

4. Whitewashing the decks and beams with quick- 
lime, has been found extremely useful in eradicating 
infection. 

5. Let the air of the well and the hold be carefully 
attended to, and such means used as will best tend to 
purify it. This may be done, by letting down into the 
well and hold a grate or pot of fire daily, and allowing 
it to remain there for an hour, and in frequently 
sprinkling a solution of chloride of lime between the 
timbers and under the limber boards. 

6. The ship should above all things be kept well 
aired, and as dry as possible. Dr. Blane recommends 
that scuttles be cut in the sides of frigates destined for 
the West India station, in order that a free circulation 
of air may be maintained through the decks, whenever 



SIGNS OP AN UNHEALTHY COUNTRY. 147 

necessary. Some captains, who have been convinced 
by experience, that a moist or wet state of a ship is 
the most frequent cause of disease, are in the practice 
not only of abstaining from pumping in water in order 
to sweeten their ships, but bail out the water from the 
well, when the pumps will not exhaust it all, and never 
let their vessels make above five inches. Where, 
however, from previous neglect, or unavoidable leak- 
age, a ship becomes very putrid below, it may be ad- 
visable to pump in water, in order to remove these 
causes of disease from the crew. 

Signs of an unhealthy country. 

In giving directions for the preservation of seamen 
in hot and sickly climates, it will be proper to enume- 
rate the most certain signs or proofs of an unhealthy 
country — extracted from the writings of Dr. Lind. 

" The first proof of an unhealthy country is a sud- 
den and great alteration in the air at sun-set, from in- 
tolerable heat to a chilling cold. This is perceived as 
soon as the sun is set, and for the most part is accom- 
panied with a very heavy dew. It shows an unhealthy, 
swampy soil, the nature of which is such, that no 
sooner are the sun-beams withdrawn, than the vapor 
emitted from it renders the air raw, damp and chilling, 
in the most sultry climates ; so that even under the 
equator, in some unhealthy places, the night air is cold 
to an European constitution. 

" The second is, thick, noisome fogs, arising chiefly 
after sun-set from the valleys, and particularly from 
the mud, slime, and other impurities. In hot countries 
the scent of these fogs may be compared to that of a 
new cleaned ditch. Diseases, therefore, arising from 
this cause, generally take place in the night, or before 
sun-rising. 

" The third is, numerous swarms of flies, gnats, and 
other insects, which attend stagnated air, and un- 
healthy places covered with wood. 

" The fourth is when all butcher's meat soon cor- 



148 DIRECTIONS. 

rupts, and in a few hours becomes full of maggots ; 
when metals are quickly corroded on being exposed 
to the open air ; and when a corpse becomes intolera- 
bly offensive in less than six hours. These are proofs 
of a close, hot, and unwholesome spot. In such places, 
during excessive heats and great calms, it is not alto- 
gether uncommon for foreigners, especially such as 
are of a gross habit of body, to be seized at once with 
the most alarming and fatal symptoms of what is 
called yellow fever, without any previous complaint of 
sickness, or other symptoms of the disease. There 
has first been perceived an uneasy itching sensation, 
commonly in the legs, and upon pulling down the 
stockings, streams of thin dissolved blood followed ; a 
ghastly, yellow color quickly diffused itself over the 
whole body ; and the patient has been carried off in 
less than forty- eight hours. 

" The fifth is, a sort of sandy soil, commonly a 
small, loose, white sand, such as that at Pensacola, 
Whydah, and the island of Bonavista, which is found 
by experience to be injurious to health." 

2. On the air of temperate climates , more particularly 
sea-air, as a cause of disease among seamen. 

In the preceding pages, some of the diseases of hot 
climates were mentioned, and the means of preven- 
tion pointed out. The following section will be prin- 
cipally devoted to the consideration of the influence of 
cool air over the health of seamen at sea. Much may 
be done on the part of the officers as well as men, to 
diminish the unfavorable effects of cold air, whether 
moist or dry, on the health. Much should be done ; 
for the diseases which may be induced by a cold, damp 
atmosphere, may incapacitate men for duty when their 
services are most wanted. This cause of disease will 
be found to act most powerfully, when assisted by the 
debilitating effects of unusual fatigue, and of the un- 
wholesome diet a crew is at times obliged to use, in 
the course, or near the close, of a long voyage. Men 



AIR OF TEMPERATE CLIMATES. 149 

who have in a great measure recovered from some of 
the severer diseases incident to a sea-life, by the help 
of mild, warm, and dry weather, even though the diet 
has remained the same, have sunken with astonishing 
rapidity, and died, merely from entering a higher lati- 
tude in a cold season. The necessary exposure, inci- 
dent to ordinary ship duty, in the cold and damp air 
into which they have newly, and perhaps suddenly ar- 
rived, has as suddenly been followed by an astonishing 
fatality. It is therefore of the last importance that 
men situated as those alluded to, should, as far as pos- 
sible, be removed from the influences of cold and 
moisture. 

The diseases, by which most suffering may be en- 
dured under these circumstances, are, complaints of 
the chest, rheumatism, and the scurvy. The first, 
from the imperfect means of relief afforded on ship- 
board, and the perpetual new exposures of a sea-life, 
will in many cases become a chronic complaint, and 
from the diseased condition of the lungs induced by it, 
be followed by consumption. Hence we actually find 
that a large proportion of the deaths, which happen in 
our marine hospitals, are from pulmonary consump- 
tion. Chronic rheumatism, if not so fatal, is hardly a 
less distressing complaint than the one just mentioned. 
Men are disabled by it, they are rendered unfit for 
duty ever after, and this too, generally, in the prime of 
life. The consequence is, that they either become the 
permanent residents of a hospital, or lead an useless, 
vagrant life in the streets. The scurvy, which occurs 
in all climates, though more frequently in the cold and 
temperate, will be considered hereafter, when speak- 
ing on the subject of diet. To prevent these diseases 
will be a much easier task than to cure them. When 
a man falls sick at sea, nothing is more common, than 
either to consider his complaints imaginary, or t3 take 
up the impression that the disease, from some fancied 
resemblance, is exactly similar to one casually observed 
by the patient, at some previous time, in some one or 
more of his shipmates. The next step is most vigor- 



150 DIRECTIONS. 

ously to adopt the treatment which in such case was 
found to be salutary. " A man who had been ex- 
tremely ill of the fever of Calcutta, suffered a relapse 
at sea ; calomel had been prescribed by a physician 
in the first attack with advantage, and the same reme- 
dy was now freely used by the man himself at sea. 
He recollected also that he had seen a severe case of 
fever treated successfully by dashing pailsful of sea- 
water over the patient, and at four in the morning, 
went on deck and submitted for some time to the same 
treatment. His superior officer remonstrated, and 
forbid the men to continue or repeat the operation. 
The calomel and cold affusions, however, were re- 
peated at the same time the next morning. Delirium 
and violent fever followed, and although the patient 
survived the first consequences of the treatment, he 
ultimately sunk exhausted under the disease." 

In temperate climates, coughs and colds, pain in the 
side, difficulty of breathing, with heat of the skin, and 
thirst, are common complaints of sailors, and seem to 
be caused as follows. The apartments in which sailors 
sleep are extremely liable to become heated at night, 
in consequence of the number of men sleeping in them 
at the same time, and from their necessary closeness 
at such periods. In order to avoid the evils which 
would follow from allowing a free current of air 
through the berth-deck at night, the avenues to the air 
are closed, and the sailors take their watch on deck in 
a full perspiration, or at least in a state which renders 
them peculiarly susceptible of inflammatory diseases. 
Hence the inflammatory affections of the lungs under 
consideration. The most obvious causes are here 
principally alluded to ; the symptoms and treatment 
are given in the former part of this work. How are 
we to prevent these evils ? To diminish the number 
and lessen the violence of lung diseases, in as much as 
they proceed from the causes now mentioned, it would 
seem principally necessary to diminish the exposure of 
men to cold, especially after being in a situation with 
regard to warmth, of all others the most favorable for 



AIR OF TEMPERATE CLIMATES. 151 

the production of these affections. To keep the berth- 
deck cool at night, without exposing the men while 
asleep to a free current of air, the air-pipes lately in- 
vented by a Mr. Sutton are admirably contrived. 
They consist of tubes leading from the berth-deck and 
hold, into the open air. Wind-sails need not be men- 
tioned, as they have been in use time out of mind. 
" The extreme of cold ought equally to be avoided 
during sleep. Many pulmonic affections are caught 
by men falling asleep in the open air, on their watch." 
If men must be turned out at night, to take their 
watch, and in case of sudden squalls, storms, &c, 
they may be still farther exposed, they are to be 
guarded from the evil consequences which may ensue, 
by proper clothing, particularly by flannel worn next 
the skin, and by overcoats of tarpaulin or India-rubber, 
the cheapness of which at the present day will enable 
the officer of the deck and helmsman to be always 
provided for stormy weather. This will be an essen- 
tial precaution against such inflammations, in cold cli- 
mates and seasons. Another, however, equally im- 
portant, is to change the clothing when wet ; for which 
purpose every sailor should be provided with at least 
two or three changes of clothes, and should avail him- 
self of every fair day to dry them. Other means for 
lessening exposure to damp air, whether warm or cold, 
have been particularly mentioned in the former part of 
these directions. 

With regard to rheumatism, the same causes ope- 
rate in producing it, as catarrhal affections. More 
frequently, however, it is induced by wearing wet 
clothes and sleeping in the cold. Persons who are 
thus exposed, while under the influence of mercury, 
are more likely to suffer, and are with great difficulty 
relieved. As a preventive of rheumatic attacks, thick 
flannel, constantly worn next the skin, is highly im- 
portant. Being a bad conductor of heat, it prevents 
the body from experiencing such sudden changes of 
temperature, as it does when cotton or linen are worn. 



152 DIRECTIONS* 



DIET. 



Diet is properly divided into solid food and drink* 
Of the former, the chief articles given out for a ship's 
company, are salted meat, biscuit, and pease. The 
first, though unavoidably used in this state, may be 
considered, more than any other article employed, as 
the cause of disease ; and as it cannot be corrected 
either by the biscuit or pease, it requires either to be 
abridged in the quantity used, or else to be conjoined 
with such vegetables as are of a correcting nature. 
But as a sailor's life in a merchant vessel, is a hard 
one, and those subjected to it require a large propor- 
tion of animal food, the quantity usually allowed can- 
not well be diminished. The only alternative then, is 
to qualify the salt provisions by such vegetables as 
correct their bad qualities, particularly that of pro- 
ducing scurvy. These vegetables are, all the succu- 
lent or juicy fruits ; and such should be laid in, as are 
capable of preservation during sea voyages. Among 
the best are lemons and oranges. Since the juice of 
the former of these articles has come into general use 
in the British navy, scurvy has quite disappeared. 
" The power it possesses over this disease," says Sir 
Gilbert Blane, "is peculiar and exclusive, when com- 
pared to all other alleged remedies. Its efficacy may 
also be stated as singular when compared to that of 
any other remedy in any other disease. It is a certain 
preventive as well as cure ; no other remedy yet 
known, can ward off this dreadful scourge of mari- 
ners, for an indefinite length of time, under the use of 
salt provisions." 

In the former part of this work I spoke particularly 
of this acid in a concrete state, as being valuable both 
for its antiscorbutic qualities, and imperishable nature. 
In the latter respect it is worthy of a place in every 
medicine chest. The article is, however, expensive, 
and on this account, may be objected to. In this case 



DIET. 153 

I would strongly recommend supplying ships on long 
voyages, with the lemon juice, as is done in the Brit- 
ish service ; since as much can be laid in for a trifling 
sum, as will be adequate to every medicinal purpose, 
and without its taking up much room. The quantity 
which, in the British navy, has been found sufficient to 
ward off the scurvy during a six months' cruise, is 
one ounce to a man per day. At this rate a gallon 
would serve for ninety-six days, which is but little 
short of the average length of East India passages. 

In concluding the subject of animal food it may be 
well to describe a new method for preserving fresh 
meat, which was proposed by a Mr. Appet, and has 
been found by ample experience, to be perfectly suc- 
cessful. The method is as follows: — " The fresh 
meat is put into a pot, the bones being first removed, 
to be boiled in the ordinary way. When it is about 
three-fourths boiled, it is to be taken out and put into 
jars, which are filled up with broth made from other 
portions of the same meat. The jars are then corked, 
luted, and put into bags ; they are newly placed in a 
boiler of cold water, heat is applied till the water 
boils, and the boiling temperature is kept up for an 
hour ; the fire is then extinguished, the water then 
drawn off from the boiler, and the bottles or jars 
taken out, which completes the process." For the 
sick and convalescent a sufficient quantity of provis- 
ions thus prepared, might be supplied with little ex- 
pense, and hereafter, it may be managed on a larger 
scale, so as to render fresh provisions occasionally 
available to the whole of a ship's company. 

The next article of sailors' diet to be considered is 
bread. It is given at sea in the form of hard biscuit. 
By long keeping, these lose much of their nourishing 
principle, and in warm climates they are liable to be- 
come acrid and produce complaints of the bowels. 
To avoid the danger of sickness from this source, it 
would be better that only a certain quantity of biscuit 
should be carried to sea, and an equal or greater pro- 
13 



154 DIRECTIONS. 

portion of flour, of which bread could be made, 
Flour, by being well pressed and rammed, will keep 
as long as biscuit, and can be stowed in one fifth part 
of the space. Thus the freight of it would be less 
than that of biscuit ; and it could be baked as occa- 
sion might require. This plan of baking at sea has 
been constantly practised in the French navy ; and 
has likewise been adopted in the British service at 
different times, under peculiar circumstances, when 
the superior advantages of it have been very appa- 
rent. What is chiefly wanted, to render it complete, 
is a substitute for yeast ; and such a substitute may be 
formed in the following manner : " Let a quantity of 
yeast be spread thin upon boards, and exposed to a 
moderate degree of heat, so that the humidity may be 
evaporated, and that it may be left in a dry granulated 
state. It must then be put into phials well corked and 
sealed. Let there be next a strong solution of honey, 
or molasses and wort, into which throw a small pro- 
portion of the above powder, and in the ninetieth de- 
gree of Fahrenheit a brisk fermentation will be soon 
excited, perfectly qualified for every purpose for 
which wort is employed. Bread made in this manner 
will possess every advantage of that baked on shore ; 
and the trouble attending the preparation of it will be 
very trifling, compared with the benefit which both 
the healthy and the sick will derive from it." 

Upon the articles of pease, or beans, we have little 
to say. They are evidently very nutritious, and agree 
well with the stomach of a seaman, whose digestion 
is strong. 

Indian meal, rice, barley, raisins, and molasses are 
articles much used at sea, and make up an agreeable 
variety. To these, potatoes are a most valuable addi- 
tion, as they are known to keep a great while in warm 
climates, and, as we have observed while speaking on 
scurvy, are in their raw state an excellent antiscor- 
butic. 

" One article we must not omit to mention here as 



DRINK. 155 

being a good one, in so far as it renders that part of 
the diet, which consists of grain and vegetables, more 
palatable, and thereby induces the seamen to eat 
more ; this is butter. The principal objection to it is 
its tendency to rancidity, and to corrupt in a warm 
climate ; but even this inconvenience may be coun- 
teracted by proper precaution. By the following 
method it may be preserved sweet, and in a solid 
state, during a three years' tropical station, provided 
it was originally in this condition. Instead of firkins, 
let it be put in waxed canvass bags, containing each 
about fifty pounds weight. Let these bags be thrown 
into casks constantly kept filled with salt water, which 
should be renewed once or twice a week, according 
to circumstances, by drawing off the old from a cock 
fixed near the lower end, while the new water is ad- 
mitted from a bunghole made in the upper end. By 
this plan, the butter will be preserved always sweet." 

The above remarks on the salutary effects of acid 
fruits, and juices, in sea diet, may lead one to attach 
an undue importance to them at all times, and to use 
them freely, even in sickly ports. In such situations 
it must be recollected that scurvy is not to be appre- 
hended, and that large quantities of fruit, especially if 
cold or unripe, are oftentimes productive of cholera 
morbus, fluxes, and fevers. This circumstance was 
particularly mentioned, when speaking on " the air of 
tropical climates as a cause of disease." 

From the consideration of seamen's food, we pro- 
ceed to that of drink ; and first of water. 

" Water is the best, and certainly the only natural 
drink of man. It has been considered by many as 
one of the prevailing causes of scurvy, when of a bad 
quality. As the health and comfort, therefore, of the 
men at sea depend so much on its purity, particular 
attention should be paid to this beverage. Spring wa- 
ter is preferable to any other for sea use, seeing that 
it is less apt to be impregnated with decayed vegetable 
and animal substances, than running and stagnant 



156 DIRECTIONS. 

waters. This preference is more especially to be at- 
tended to in warm climates, where every thing, it may 
be said, teems with life, and where the materials of 
putrefaction are so abundant. Where river water 
must be taken, which often happens in warm climates, 
although it may be drawn as near as possible to its 
source, yet certain precautions should be employed 
before it is used. These consist in throwing a hand- 
ful of lime into each cask, or dissolving two ounces of 
alum to a hundred gallons, or passing through it a red 
hot iron several times, or even throwing into it a little 
burnt biscuit." Water, however pure it may be col- 
lected, is always apt to corrupt when kept in wooden 
vessels, and this is one of its greatest inconveniences 
at sea. Different methods have therefore, been fallen 
upon, either to prevent this corruption, or to counter- 
act it when it has taken place. The former consist in 
various modes of preparing the vessels that hold the 
water ; and it must be observed, that there is a great 
difference in this respect, between a new cask made 
of moist wood, and one that has been hardened and 
seasoned by age and use. 

One method of preparing the vessel is by firing the 
cask, when putting the staves together, until a charred 
coat is extended over its whole surface. This will 
preserve the water pure and sweet for any length of 
time, and will have the same effect as another im- 
provement, that of filtering it through charcoal, which 
has been found to correct the most putrid state of the 
fluid, and to render it wholesome and pure, although 
somewhat insipid. The most common expedient, 
however, for the purification of water, has been by 
quicklime. 

This is equally effectual, whether slacked or un- 
slacked ; but should always be carried slacked to sea, 
to obviate the danger arising from heat, which is apt 
to ensue on its being touched by water in its unslacked 
state. 

To counteract the bad taste of water in a state of 



DRINK. 157 

putrefaction, vinegar and other vegetable acids are 
usually employed. A still better method is, to put 
two ounces of chloride of lime into 60 to 100 gallons 
of water ; after a day or two the water, when allowed 
to stand awhile in an open vessel, Avill be freed from 
its putrid smell. 

Various methods have been used for purifying wa- 
ter by filtration. The dripping stone is often used for 
this purpose, but for a large crew the quantity it 
affords is insufficient. Pouring it through gravel or a 
layer of gravel and charcoal, will afford a more abun- 
dant supply, and be equally serviceable. 

A very simple filtering machine is mentioned by 
Dr. Blane. " Let the narrow mouth of a large funnel 
be filled with a bit of sponge, over which let there be 
a layer of clean gravel, or of sand, covered with flan- 
nel, and over the whole another layer of sand. Mud- 
dy or offensive water, being poured into this, runs or 
drops out clear ; and care must be taken to change 
the sand, sponge, &c, frequently, as they will become 
loaded with the impurities of the water." 

These remarks on the purification of water, we shall 
follow with directions for distilling sea water, for the 
benefit of those who have used or lost all their fresh 
water at sea, and may not have taken the precaution 
of carrying out a still-head. 

" When sea water is boiled in a close covered pot 
or vessel, it may be observed, that the steam arising 
from it is converted into fresh water on the inside of 
the cover of the pot. From a pot of thirteen inches 
diameter, by frequently removing the cover, and pour- 
ing off the water collected upon it, a gill of fresh wa- 
ter may be procured in an hour. The cover of the 
pot should be, at least, five or six inches above the 
surface of the sea water, to prevent its boiling up 
to it. 

" Let us suppose a ship at sea to be in distress for 
want of water, having eight men on board, and that 
the pot for boiling their provisions can contain five 

13* 



158 DIRECTIONS. 

gallons and a half, being twelve inches in diameter ; 
by the following simple contrivance, with only a tea- 
kettle, a musket, and a cask, one gallon of fresh wa- 
ter may be procured every three hours, which is a pint 
for each man. 

" File off the handle of the tea-kettle, and fix the 
head of the kettle when inverted, into a hole made for 
that purpose in the cover of the pot ; this will prove a 
complete still-head. Take the barrel of the musket 
out of the stock, and after unscrewing the breeching 
pin, pass the barrel through the cask by two holes 
made on each side, w T ith a proper descent for the dis- 
tilled water to run off; then stop up the holes in the 
cask, and fill the cask with cold sea- water ; w T hich will 
be a refrigeratory or cooler to condense the steam. In 
order to carry on the distillation, they should be joined, 
by inserting the spout of the tea-kettle into the upper 
end of the musket barrel, all the joints and places 
from whence the steam could escape should be luted or 
stopped up ; a paste, composed of equal parts of chalk 
and meal, moistened with salt water, will do this effec- 
tually, and may be easily obtained ; the tea-kettle and 
cover of the pot should also be kept down by a weight 
to prevent the steam from forcing them up. 

" If the cask should be too near the fire, the musket 
barrel, in which the steam is condensed, may be pro- 
longed by the addition of the barrel of another musket, 
or by wooden pipe. If the barrel of another musket 
be used, whose bore is not large enough to receive the 
extremity of the former, one end of it should be heated 
in the fire, and dilated with a marline spike. If a 
wooden pipe be used it should not be bored with a hot 
iron, as it is found by experience, that burnt wood 
will impart a permanent disagreeable taste to the dis- 
tilled water. 

" If we may suppose a ship at sea to have no tea- 
kettle on board, then let the wooden hand-pump, with 
which the water or beer is pumped out of the casks, 
be cut through obliquely, and, joined, so as to form an 



DRINK. 159 

acute angle. One end of this tube should be fixed 
into the hole made in the cover of the pot, the other 
should be fastened to the musket-barrel. By this 
nearly the same quantity of water may be procured 
as by means of a tea-kettle. 

" It may justly be supposed, that the coppers used 
for boiling the provisions will, in every ship, contain 
more than the proportion of two quarts of water for 
every person on board ; if these were furnished with 
proper still-heads, they would be sufficient to yield in 
distillation the proportion of three pints of fresh and 
wholesome water for each man. In a British ship, 
called the Dorsetshire, by means of a tea-kettle and 
musket-barrel, twenty-two quarts of sea- water yielded 
nineteen quarts of fresh water in four hours, at an ex- 
pense of ten pounds of wood." When sea-water has 
thus given off two-thirds of its bulk, the remaining 
third will be too salt for distillation, and should be 
thrown away, and the vessel should be replenished 
from the sea. 

" The distilled sea-water is purer than spring, river, 
and even rain water. The taste which it receives from 
the distilling vessel is, in some measure, lessened by 
throwing away the first running from the still ; and is 
wholly removed by keeping the water for some time, 
or exposing it to the air, when it will be found an ex- 
cellent well-flavored water, which will keep perfectly 
sweet for many years, if put into clean vessels. 

" In cases of extremity, such is the constitution of 
our body, that thirst may be alleviated, and the morbid 
consequences, arising from a want of water, obviated, 
by wetting the skin or surface of the body with sea- 
water, which becomes thus inhaled, and answers, in 
some degree, the common purpose of drink. 

" The pernicious effects of ardent spirit in very hot 
weather, and when heated by exercise, have already 
been adverted to. In such situations, molasses and 
water, tea and sugar, small-beer, lemonade, soda- 



160 DIRECTIONS 

water, or water slightly acidulated with vinegar or cider, 
are most conducive to health." 



OF CLOTHING. 

The chief object of attention in a seaman's clothing 
is to guard against moisture. This moisture, accord- 
ing to the climate he is in, must be accompanied either 
by heat or cold. A covering, therefore, which will 
protect the body in both situations, is the great object 
to be aimed at ; and no substance is so well calculated 
for this purpose as woollen. By its use, the suppres- 
sion of the discharge from the skin, the great source of 
all inflammatory diseases, is prevented, and the skin 
itself being kept as it were moistened by its own se- 
cretion, the natural heat is thus retained, and the access 
of the external air prevented. 

Although in the warmer climates this covering is 
less necessary for the sake of warmth, yet it is well 
known, that exposure of the body is apt to produce a 
general uneasy irritation upon it, and even to lay the 
foundation of many dangerous affections. Besides this, 
the excessive discharge of the skin, which then takes 
place, is absorbed by this covering, and thus the after 
consequences of cold are avoided. Even the night 
damps, in such situations, are greatly counteracted ; 
and the dry bellyache, and many other complaints, 
seldomer occur in the West India service, than they 
did before woollen was preferred to cotton or linen. 
From the advantage of such clothing, it is of great 
importance that every seaman should have a proper 
supply of it, and that the captain should lay in a small 
supply for his crew, suited for the station to which the 
ship is destined. This subject merits particular atten- 
tion from the captain, for in general, sailors are too 
indolent and improvident to suit their dress to circum- 
stances, unless they are forced to it ; " nor is any thing 
more common, than to see some of them with linen 



FOR THE PREVENTION OF DISEASES. 161 

trowsers in the severity of winter, and a pair of greasy 
Avoollen ones in the hottest of summer." 

In hot climates, the dress should be white, even to 
the hat and shoes. In cold climates a kind of cloth 
called Fearnought is very suitable. After a rain, both 
clothing and bedding should always be dried, and 
whenever the weather will admit of it, bedding should 
be aired every day. 

On the subject of cleanliness of person and clothing, 
nothing need be here said, since every commander of 
a merchant vessel must be fully sensible of its impor- 
tance. 



CONCLUSION. 

The foregoing directions, for the prevention of dis- 
ease among seamen, may be briefly comprised in the 
following particulars : 

In hot climates. 1. In choosing anchorage to the 
windward of the land. 

2. In keeping the ship dry, clean, and ventilated. 

3. In preventing the creAv from sleeping on shore or 
on deck. 

4. In their avoiding violent exercise under a scorch- 
ing sun. 

5. In employing natives to wood and water the ship. 
Where these duties must necessarily be performed by 
the crew, to use the precautions recommended under 
such circumstances. See page 143. 

6. In avoiding entirely the use of all stimulating 
liquors, and in abstaining from the free use of cold 
fruits, and especially those that are unripe. 

7. In adapting the dress to the temperature of the 
weather ; wearing flannel, however, next the skin at 
all times. 

8. When disease of a malignant character has al- 
ready appeared on ship-board, in arresting its progress 
among the crew by the " means" formerly recom- 



162 DIRECTIONS. 

mended " to prevent the spreading of contagious dis- 
eases in a ship." See page 145. 

In cold climates. 1. In wearing flannel next the skin. 

2. In preserving the lodging rooms, whether 'berth- 
deck, cabin, or forecastle, of an equable and rather 
cold temper ature. In this way the sudden transition 
from heat to cold, so often experienced, when called 
out to take watch on deck, and which is one of the 
most productive causes of disease in cold climates, will 
be avoided. 

3. In dissipating the moisture of the lodging apart- 
ments every day with fires, and in scraping and holy- 
stoning the deck instead of washing. 

4. In changing the clothing when wet, and in keep- 
ing the bedding dry and well aired. 

5. In avoiding ardent spirits. 

While at sea, in all climates. 1. In using freely of 
vegetables and other antiscorbutics, particularly vine- 
gar and lemon-juice. An ounce of the latter per day to 
a man, or a pint for twelve days, will, as I have formerly 
observed, (p. 153) prevent the scurvy during the longest 
sea- voyages, even when confined to a diet of salt meat, 

2. In using pure and wholesome water. 

3. In observing cleanliness in person and clothing. 



THE SEASONS OF SICKNESS, AND THE DISEASES INCI- 
DENT TO STRANGERS IN DIFFERENT SEAPORTS IN THE 
WORLD. 

To owners and masters of vessels, who are fitting 
out ships for foreign voyages, it may be of some im- 
portance to know particularly when and where diseases 
are most prevalent ; and to travellers, who contemplate 
visiting foreign ports and wish to arrive in them in a 
healthy season, this subject must be particularly inter* 



SEASONS OF SICKNESS. 163 

esting. The account here furnished is very imperfect, 
and is principally taken from the writings of Lind and 
Turnbull. 

Seasons of sickness, and the diseases in the sea-ports of 
the United States, and the British ports eastward. 
New-England and Eastward. In the summer and 
autumn, there are a few cases of inflammatory fevers, 
occasionally a case of low typhus and some bowel 
complaints. Bilious remittent fever occurs very rarely, 
and still more so intermittent fever. In the heat of 
summer, the yellow fever appears once in twenty or 
thirty years, in one or two of the principal sea- ports. 

The winter season is most sickly, and the prevailing 
diseases are, inflammations of the chest, as pleurisies, 
catarrhs, sore-throat, &c. Rheumatism and frost-bites 
are very common disorders. The greater number of 
deaths are occasioned by pleurisies and consumptions. 

Middle and Southern States. Travelling along the 
sea-board, from New Jersey to Virginia, where the 
heats are greater, and the soil more moist, especially 
in the neighborhood of woods or stagnant water, we 
find agues, fevers, and fluxes of very frequent occur- 
rence among strangers. The agues are apt to termi- 
nate in liver complaints and dropsies. The winter 
season is, however, less productive of inflammatory 
complaints here than hi New England. 

In Carolina and Georgia, we find the summer and 
autumnal diseases last mentioned, much more obstinate, 
acute, and violent. In the months of July and August, 
they sometimes partake of the nature of West India 
fevers. The winter season is healthy. 

In East and West Florida, the summer diseases ap- 
proach still nearer to those of the West Indies. In 
some seasons the excessive heat, with the concurrence 
of other circumstances, produces the yellow fever. In 
other seasons, however, there is quite an entire exemp- 



164 SEASONS OF SICKNESS, ETC. 

tion from this and all other violent fevers, from Carolina 
to NeAv Orleans. Pensacola seems to be rendered 
unhealthy by its sandy and barren soil. In Mobile, 
intermittent fevers are very prevalent in the months of 
July, August, and September. The winter seasons 
are generally healthy in the Floridas. 

Most uniuholesome seasons, and the diseases in the West 

Indies. 

Comparative degree of health in the different islands. 
u The most healthy of all the English possessions, in 
this part of the world, is the island of Bermudas ; next 
to which is the island of Barbadoes, if we except that 
spot of ground upon which Bridge-town, its capital, is 
situated. The air, in many parts of St. Christopher's, 
is also pure. That of Antigua is bad, and that of 
Jamaica is reckoned still more unhealthy ; though much 
less so than it formerly was. The color of the Euro- 
pean inhabitants in the island of Montserrat, is a proof 
of the salubrity of its air ; the same may be said of 
Nevis. In general, the rainy season in those islands 
happens in August, September, October, and Novem- 
ber. In the settlements on Grenada, the Grenadines, 
and particularly at Tobago, the health of the inhabi- 
tants has been little attended to. In the island of St. 
Vincent, the town of Kingston is rendered very un- 
healthy by an adjoining morass. 

"With respect to the settlements of other European 
nations, we shall briefly observe, that the French set- 
tlement of Cayenne has proved very sickly. The 
climate of St. Domingo is also unhealthy ; that of 
Martinico less so. At Guadaloupe, Martinique, and 
most of the other French West India islands, there 
are low swampy grounds, commonly called Basse 
Terre, which are particularly unhealthy. 

The Dutch settlements at Surinam, St. Eustatia, and 
Curracoa, are all very unhealthy. 

In different parts of the Spanish West India domin- 



IN THE WEST INDIA ISLANDS. 165 

ions, the air varies greatly in point of purity, according 
to the situation of the places. The port of Havana, 
in Cuba, is sickly, while the highlands are not. The 
city of Mexico is very healthy, while La Vera Cruz, 
its sea-port, is remarkable for its bad air. It is observ- 
ed, that in the West Indies the periodical rains, and 
the sickness which attends them, are much more violent 
in the hot, marshy, woody, and uncultivated places 
upon the continent, than upon the adjacent islands ; 
the inland provinces are, however, found to be, in 
general, more healthy than the sea-coast. "Were we 
to take a survey of the whole coast of the Spanish 
continent in the bay of Mexico, we should find few 
sea-port towns or rivers, during the rainy season, tole- 
rably healthy. 

" Shoals of large and ravenous sharks, crowding 
into the harbors, a dark thick cloud to the southward, 
with thunder and lightning, slowly approaching, foretell 
the coming on of the sickly season, and are the awful 
preludes of those impetuous torrents which, in a few 
days, burst from the clouds, and cover with water the 
whole face of the country." 

" Some of the harbors in the bay of Mexico, and 
those generally the most secure, prove fatal to Euro- 
peans, besides the usual causes of sickness, from want 
of a due ventilation. Thus in Port Maho, near the 
island of Ruattan, ships He in a basin of water so 
environed with high mountains, that the wind can have 
no access to them ; in this respect, they suffer more 
than even at English-Harbor, in Antigua. The stag- 
nated air thence becomes so unwholsome, that men, 
after being there a few days, are suddenly seized with 
violent vomitings, headaches, deliriums, &c, and in 
two or three days more, the dissolved mass of blood 
issues from every pore. 

" The bay of Honduras and the Musquito shore, 
although very unhealthy, are far better than Carpenters 
river and Bio Morte, or the river of Death, in the Gulf 
of Mexico. This was so named by the Spaniards from 

14 



166 SEASONS OF SICKNESS, ETC. 

the death of all that nation, who, at different times, 
have attempted to make a settlement upon it ; the 
English, however, have since, by settling on a different 
spot of ground, been more fortunate, and call it the 
New river. 

The most frequent and fatal diseases in the West 
Indies are, 

1. Fevers, viz., the bilious remittent fever and the 
yellow fever. The former is here so violent and rapid 
that it often proves fatal between the third and seventh 
day. It chiefly prevails during the months of June, 
July, and August, beginning to abate in September. 
The latter, or yellow fever, is the most fatal disease of 
the West Indies. Its attack is so sudden and violent, 
that oftentimes the patient is thrown down, almost in- 
sensible, without any previous complaint. Vomiting 
and headache attend him till within a few hours of his 
death, when he experiences a slight abatement of his 
distress, but soon after relapses and dies, not unfre- 
quently in between twenty-four and thirty-six horn's 
from the commencement. 

2. Dysenteria, which, in point of frequency, comes 
next to fever in the East and West Indies. 

3. Dry bellyache or colic, which occurs often. 

4. Tetanus or lock-jaw. 

5. Fish poison, which is of frequent occurrence. 

" It is a general observation that women enjoy much 
better health in the West Indies than men, and are not 
so subject to the yellow fever as they are, owing, pro- 
bably, to their more temperate way of living. 7 ' 

The following table, recently drawn up by the Brit- 
ish commissioners of health, is extracted from the 
London Quarterly Review, of July, 1840, and exhibits 
the annual ratio of mortality per one thousand mean 
strength of British troops in the British West India 
islands. 



IN THE WEST INDIA ISLANDS. 



167 





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168 SEASONS OF SICKNESS, ETC. 

The Western shore of South America and the Islands 
of the Pacific. 

In turning Cape Horn, whether outward or home- 
ward bound, inflammatory affections are very com- 
mon, as rheumatism, catarrhs, pleurisies and pneumo- 
nias, all which should be carefully guarded against by 
warm clothing. 

The coast of Patagonia is healthy, and nearly so is 
the coast of Chili, particularly Valparaiso ; but the 
inland is less so. Santiago, situated ninety miles in- 
land from Valparaiso, is remarkable for the extreme 
heat of the day and coldness at night. Remittent and 
bilious fevers are here very frequent. 

Lima is tolerably healthy, much more so than places 
of corresponding latitude on the western shores of 
Africa. The air is too arid and is unfavorable to pul- 
monary diseases, it is moreover enervating and injuri- 
ous to persons who reside here for any length of time. 
The remarkable property of the atmosphere to dry up 
moisture, (as is evinced in the manner of curing jerked 
beef merely by hanging it in the open air,) is probably 
one cause of there being no malignant diseases arising 
from putrid exhalations. 

Coquimbo, situated three degrees further north, is 
very healthy. From Guayaquil to Panama, the coast 
during the wet season is rather unhealthy, fevers and 
fluxes, and liver complaints being the prevailing dis- 
ease. But as a general remark, it may be said that 
the whole western coast of America is quite free from 
all malignant fevers, and from the destructive fluxes that 
prevail in corresponding latitudes in the other hemi- 
sphere. 

All the islands lying in the eastern longitudes of the 
Pacific, as the Sandwich, Fejee, Friendly, Society, 
and Gallapagos, and all others near them, are very 
healthy. Essex Bay, situated in the Gallapagos, is 
often visited by whalemen. Emigrants from Guaya- 
quil have made settlements there. 



IN THE MEDITERRANEAN. 169 

Payta, an island only three days' sail from Callao, 
has a clear, dry atmosphere, and regular winds that 
moderate the extreme heat of the day, and the changes 
of temperature are very slight. It is the port of Piura, 
a city having a population of 4000, and derives its 
name from the purity of its air. The cruising ground 
of whalemen is directly off this port, and in conse- 
quence of its excellent climate, fine market, and easy 
access, is much frequented by them. 

Diseases in the seaports of Great Britain. 

Diseases along this coast vary very little from those 
in the northern ports of the United States, excepting 
that intermittent fevers are frequent, which are attrib- 
uted to fogs and east winds. " An east wind here is 
usually accompanied by a cold, damp, and unwhole- 
some vapor, which is observed to affect both animal 
and vegetable health, and in many places to give rise 
and obstinacy to intermitting fevers, as also to produce 
frequent relapses." In the southern part of England, 
particularly in the British Channel, pleurisies are less 
violent than in North America. The complaints most 
frequent and troublesome, are typhus or common fever, 
intermittents, rheumatism, catarrhs, and consumption. 

Sickly season and diseases of the Mediterranean. 

The most fatal disorders to strangers on board ships, 
are consumptions. This applies more particularly to 
the crews of men of war, or vessels stationed for a 
long time in this sea. In some of the islands, particu- 
larly Minorca and Majorca, pleurisies are very preva- 
lent in winter. Catarrhal affections and rheumatisms 
are frequent in every port in the Mediterranean. 

In the summer season, the neighborhood of marshes 
is sickly, especially the Pontine marshes near the Tiber 
in Italy, where intermittents and bilious remittents 
are very fatal. 

The African shore of the Mediterranean, excepting 
when the plague prevails, is very healthy, from the 

14* 



170 SEASONS OF SICKNESS, ETC. 

straits to Tripoli. From Tripoli to Alexandria, Jaffa, 
and Smyrna, some of the ports suffer more or less 
every year with the plague. " It is said to be most 
prevalent soon after the inundation of the Nile, or 
rather its recession. Next to the plague in frequency, 
comes sore eyes. It is called Egyptian ophthalmy. 
If less fatal than plague, it is more distressing, and is 
as frequent among crews in vessels at anchor, as 
among people on shore. Besides these epidemics, 
that are peculiar to this country, strangers are apt to 
be seized in the summer season with bilious disorders, 
fluxes, and fevers. 

Sickly season^ and Diseases on the Western shore of 
Africa. 

The new colony of Liberia, and other settlements 
along this coast, and the constantly increasing inter- 
course with them for the purposes of trade, require a 
particular account of their climate and diseases. 

The British settlements in Western Africa, are 
Sierra Leone, Gambia, the Isles de Loss, Cape Coast 
Castle, and Accra. They are scattered over a line of 
coast, which, from St. Mary's on the Gambia to Ac- 
cra, is nearly 1600 miles in extent, and which every 
where exhibits the same remarkable hostility to foreign 
constitutions. The coast is generally low ; its eleva- 
tion from Senegal to Sierra Leone, a distance of 100 
miles, being only a few feet above the ocean ; its 
rivers are sluggish and flooded during rains, when the 
mud they deposit, and the moisture they supply, give 
rise to an interminable wilderness of forest and brush 
wood, among which lies rotting the decayed vegeta- 
tion of many centuries. 

In the Sierra Leone command, are comprised the 
stations of Sierra Leone, the Isles de Loss, and the 
Gambia. The peninsula of Sierra Leone, occupies 
an intermediate position in the British settlements 
along this coast, being about 300 miles to the south of 
the Gambia, and 1100 to the north of Accra, and 



ON THE WESTERN SHORE OF AFRICA. 171 

comprehends a tract of land extending about eigh- 
teen miles from north to south, and twelve from east 
to west. 

St. Mary's, near the entrance of the Gambia, is 
fatal to foreigners, by reason of the great degree of 
heat, (the thermometer often indicating 100° in the 
shade,) and the putrid exhalations arising from its 
shores. The rainy season commences in July and 
continues about four months, and the diseases that 
accompany and follow it are, intermittent, remittent, 
and continued fevers, dysenteria, and cholera-morbus. 
These prevail at all seasons among recent visiters, and 
in a milder form often attack seasoned residents. 

Free Town, the capital of Sierra Leone, is about 
six miles from the mouth of the Bunch river, on the 
south side, and from 40 to 70 feet above the general 
rise of the river, which is here about 10 miles across. 
No situation could be more unfavorable for foreign 
constitutions ; the supply of good water being the 
only thing in its favor. The rainy season lasts from 
June to October, and is introduced and closed with 
tornadoes. In one year there were fifty-four of these ; 
no part being more liable to them than this and the 
grain coasts. 

The temperature at Sierra Leone, is generally not 
higher than 95°, but the tranquil state of the air makes 
it very sultry and oppressive. The mean temperature 
is about 83°. Continued and remittent fevers, (com- 
monly called yellow fever) intermittents, dysentery, 
cholera-morbus, enlargement of the spleen, and 
chronic inflammation of the liver, are the most com- 
mon diseases, and are annually fatal to about two- 
fifths of the whites. Of these, about four-fifths die of 
fevers, arising from the same causes, though of various 
types. 

After passing Sierra Leone, the country is hilly and 
woody. As we approach the bay of Sherbro, it 
grows more level. The distance here is aloat 80 
miles ; within which empty four considerable rivers, 



172 SEASONS OF SICKNESS, ETC. 

This bay is formed by a range of low islands, whose 
south-east extremity touches the continent, and leaves 
it obliquely, opening wide to the north-west. The 
country is low and swampy, and though a sandy beach 
edges the land, the soil is a deep and heavy clay. 
For more than 70 miles beyond, the country is low 
and swampy, with many rivers, until we arrive at 
Cape Mount. This mountain is on the south side of 
a large river of the same name. The elevation soon 
lessens, and in a few miles the same lowness is seen. 
The country is thickly wooded. Cape Mezurado, is 
about 50 miles beyond cape Mount, and is the south- 
ern barrier to a river bearing the same name. These 
rivers overflow during the rains. 

The Grain Coast begins at the Mezurado, (6° 30/ 
north latitude, 10° west longitude,) and terminates at 
cape Palmas, (4° north latitude, 7° 20' west longi- 
tude.) The land is uniformly low, with thick woods, 
and many small streams, navigable only by canoes. 
The coast is shelving, and the swell from the Atlantic 
renders the shore generally impracticable. 

The villages are on the sea side, near the streams* 
The soil is deep, rich, and heavy. " The plain be- 
comes almost an entire morass during the rainy sea- 
son, hence rice is mostly cultivated and eaten by the 
natives. Occasionally, one or more trees rise high 
above the rest, and form the most striking landmark, 
Places designed for the growth of farinaceous vegeta- 
bles or roots, have their exuberant, but now withered 
productions, towards the end of the dry season, set on 
fire, and the seeds are then put into the ground." 
The quantity of rain is nearly the same as in the part 
of the coast last described. This season begins in 
June, and lasts about four months, with almost con- 
tinued thunder and lightning, the wind being generally 
south-west. After this is about a month of fogs, with 
an almost tranquil atmosphere. 

The prevailing diseases of Liberia, are fevers and 
fluxes, and diseases of the liver. Almost every for* 



ON THE WESTERN SHORE OF AFRICA. 173 

eigner is attacked with fever within the first nine 
months, varying in type and severity according to the 
prudence he exercises in his diet and regimen, and in 
the other known measures that experience has taught, 
as being effectual in preventing or mitigating its force. 
In reflecting upon the sickness and loss of life sus- 
tained by this colony since its commencement, it 
affords some relief to know that it is every year be- 
coming more healthy. 

Ivory Coast, commences at Cape Palmas, and ex- 
tends to Cape Lahou, in 5° north latitude. It is, like 
the Grain Coast, low and swampy ; toward the Gold 
Coast it is more level, like table-land. For 700 miles 
from Sherbro to Cape Lahou, there is a uniformity in 
soil and seasons, in the luxuriance of the vegetable 
kingdom, in the natural scenery, and in the character 
and severity of diseases. 

The Gold Coast runs about 500 miles, to Rio Volta. 
Apollonia, the first settlement, is in a rich, fertile 
country. Next to it are Axim and Hollandia, belong- 
ing to the Dutch ; Dixcove, Succondee, and Commenda, 
belonging to the English ; also Anamaboo, and beyond 
this the Accra country, where English, Dutch, and 
Danes, have settlements in a finely cultivated and 
comparatively healthy country. The rains commence 
in May and terminate in the beginning of August. 
Between Accra and Rio Volta, which terminates the 
Gold Coast, are the settlements of Prampram and 
Ningo, the soil of which is light, sandy, and well cul- 
tivated by the Dutch. 

The Slave Coast commences at Rio Volta, and ex- 
tends to Biaffra, in latitude 3° north. The whole 
coast is low and swampy, indented by creeks and 
rivers, the largest of which are the Formosa, old and 
new Calabar, the Croos, and Del Rey rivers. Owing 
to the extensive trade through them in palm oil, ivory, 
and ebony, these rivers are more frequented than any 
on the coast. The climate is so unhealthy that, on an 
average, not more than one half of those here em- 



174 SEASONS OF SICKNESS, ETC. 

ployed in trade ever return. " The necessity for ves- 
sels to proceed some distance up these rivers, in order 
to enter on the field of traffic, brings them within the 
sphere of action of the malaria, generated from the 
mud, ooze, and decaying matters which continually 
cover their banks. These sources of disease are 
greatly multiplied both during and after the rainy sea- 
son." The prevailing diseases are continued and re- 
mittent fevers, dysentery, and cholera morbus. 

There is a great sameness in the soil and face of 
country along the coast of Africa, from the mouth of 
the Senegal, to cape Lopez, in latitude 3° south, and 
consequently a great sameness in the nature of the 
diseases, being mostly comprehended under the names 
of fevers and fluxes. Those who arrive on the west- 
ern coast of Africa, between the Senegal and Ben- 
guela, and especially between Gambia and cape Lo- 
pez, are subject within the first nine months, and 
more frequently within as many weeks, to the endem- 
ic yellow fever, to bilious diarrhoea, to cholera-mor- 
bus, and dysentery. If a bilious diarrhoea or cholera 
precede an attack of fever in the new comer, (com- 
monly called the seasoning,) both diseases may be 
comparatively mild. 

Fevers are the most destructive diseases, and equal- 
ly fatal with those of the West Indies. The worst 
forms in the two regions resemble each other so close- 
ly, as to have given rise to the opinion that the ma- 
lignant yellow fever of the West Indies, was imported 
from the island of Bulam^ latitude 11° north. No 
doubt, however, the disease is of local origin in both 
regions, since they both abound in those marshy 
miasms which are now generally acknowledged to be 
its sole cause. There are, however, milder grades 
of fever, as intermittents and simple continued, which 
rarely prove fatal, though the former are often found 
to leave a disordered state of the liver, called ague- 
cake. Among the natives, fever is very slight, ap- 
pearing under the form of a headache, or disordered 
stomach or bowels, and is of short duration. 



ON THE WESTERN SHORE OF AFRICA. 175 

Dysentery is also common, and in new comers very 
acute. It is most frequent on the Gold Coast, proba- 
bly owing to the scarcity of good water. 

Complaints of less magnitude, but very trouble- 
some, are the dry bellyache, prickly heat, Guinea 
worm, and stroke of the sun. 

The fatal diseases prevail mostly during the rains, 
and for sometime after they have ceased. The rainy 
season begins in Senegal early in July, and continues 
till the end of October ; at Gambia, a week or two 
sooner ; at Sierra Leone, and Liberia, at the begin- 
ning of June ; and along the coast of Guinea, about 
the middle of May. These rains last about four 
months, with almost continual thunder and lightning, 
the wind being generally south-west. To the rain 
season succeeds about a month of fogs, with an almost 
tranquil atmosphere, arising from exhalations. This 
is the most noxious season. But for the almost daily 
tornadoes, which carry before them the stagnant pes- 
tiferous air in a tumultuous sweep, much of the coast 
would probably be uninhabitable. 

The following table exhibits the dreadful mortality 
that prevails in the Gulf of Guinea, as well as at 
Sierra Leone. Within a few years past the British 
government has taken possession of the island of Fer- 
nando Po, in this gulf, and made it the head quarters 
of its military establishment in this section of the Af- 
rican coast. The waste of life at Cape Coast castle, 
and at other stations along the main, made it neces- 
sary. Happy would it be were this island free from 
tropical diseases. Its commanding situation for the 
suppression of the slave trade through the gulf, ren- 
ders it a most desirable possession for the English, 
who are so heartily engaged in endeavoring to stop the 
traffic in human flesh. Would to God their noble 
philanthropy were backed by other nations of 
Europe, instead of being thwarted by the French, 
Spanish, and Portuguese flags. But Fernando Po 
was formerly very sickly, and it is to be feared will 
ever remain so under its new possessors. 



176 



SEASONS OF SICKNESS, ETC. 



From Biafra south to Cape Lopez, and the Portu- 
guese and other settlements, along the coast of Loan- 
go, Congo, Angola, and Benguela, the salubrity of 
the climate varies. St. Paul de Loango is tolerably 
healthy, St. Salvador, the most so in this division of 
the globe, whilst Benguela is very sickly. 



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IN THE EAST INDIES. 177 



AFRICAN ISLANDS. 



Of the Canaries, Cape de Verd Islands, the Island of 
St. Thomas, Princess, Fernando Po, St. Helena, 
Cape of Good Hope, Madagascar, Mascarenhas, 
Mauritius, Eastern shores of Africa. 

The Canaries are remarkable for their healthiness. 
The Cape de Verds are rather unhealthy. St. Anto- 
nio and St. Nicholas are the only two islands in that 
cluster, where strangers are exempted from a general 
sickness during the rains. These generally begin in 
July, and continue till November. Sickness is par- 
ticularly violent in the island of St. Thomas, Princess 
island, and Fernando Po. 

In St. Helena, foreigners enjoy good health. 

At the Cape of Good Hope, the settlements are 
fruitful, pleasant and healthy. Passing these, we come 
to the large island of Madagascar, where, during the 
rains, which continue from November till March, this 
island is very unhealthy, particularly the Bay of St. 
Augustine and Fort Dauphin, the two places where 
ships commonly anchor. 

The same may be said of Mascarenhas, Mauritius* 
and the barren island of Diego Reys. 

As to the eastern shores of Africa, we shall only 
remark, that Mozambique is reckoned unhealthy ; the 
country of Quiola much more so ; but the city of 
Maradoxa and Melinda are said to be tolerably free 
from disease. 

East Indies. 

In all parts of the East Indies, situated near large 
swamps, and the banks of muddy rivers and stagnant 
waters, mortal diseases are very prevalent. 

" The English have four presidentships or govern- 
ments, namely, Madras, Bengal, Bombay, and Ben- 
coolen. Formerly, Madras was the most healthy of 
these, but latterly it is least so, with the exception of 
Bencoolen, which has always been the most sickly. 
15 



178 SICKLY SEASONS IN THE EAST INDIES. 

Bengal is very sickly during the rainy season, which 
commences in June and continues till October ; the 
remainder of the year is healthy. Calcutta, belong- 
ing to this presidentship, built literally on a swamp, on 
the east side of the Hoogly, and surrounded to this 
moment by immense lakes at a few miles distant, has, 
by the draining of that part of the city inhabited by 
Europeans, become as healthy as any country of the 
same latitude on earth. There are several other places 
in this vicinity that seem to have been made healthy 
by being cleared, as Fultah, Barrackpore, Serampore, 
Chandernagore, Chinsurah. But other places continue 
sickly." 

Bombay is more healthy than Bengal, and in gene- 
ral the whole coast of Malabar is tolerably exempt 
from disease. The same may be said of Surat and 
Tellicherry on the same coast. The rains begin in 
May or June, and last four months. 

Manilla, in the island of Laconia, is remarkable for 
its healthiness. Tranquebar, a Danish settlement, is 
likewise healthy. Pondicherry, the capital of the 
French in India, is far from being unhealthy. The 
same may be said of Goa, the residence of the Por- 
tuguese viceroy in India. Batavia, the capital of the 
Dutch dominions, is annually subject to a fatal and 
consuming sickness. The rains begin in June, and 
sickness in July. 

The diseases which rage during the wet season, and 
for some time after it, in the unhealthy parts of India, 
are malignant and bilious fevers. Foreigners, espe- 
cially such as live intemperately, are also subject to 
fluxes and to an inflammation of the liver. This last 
is almost peculiar to India, and principally to the Coro- 
mandel coast. The diseases of the liver are generally 
preceded by fever, difficult breathing, and violent pain 
in the right side. The fevers of Bengal are attended 
with violent bilious symptoms. 

Genuine ideopathic inflammation of the liver is ten 
times more prevalent on the coast of Coromandel than 



ON CHOICE OF CLIMATES, ETC. 179 

on the plains of Bengal; whilst on the other hand 
intermitting and remitting fevers are ten times more 
frequent in the latter place. This is attributed to the 
greater heat, being ten degrees higher on the Coro- 
mandel coast. 



ON CHOICE OF CLIMATE, AS A REMEDY FOR CONSUMP- 
TION, WITH DIRECTIONS TO PATIENTS IN THEIR TRIAL 
OF IT. 

Change of climate stands at the head of remedies 
for consumption in its first stage, and as a palliative in 
its second stage. Not that any climate possesses spe- 
cific virtues in this disease, for statistics of health and 
mortality show that there is no immunity from con- 
sumption in any quarter of the globe. But some cli- 
mates are more salutary, to weak and irritable lungs, 
than others ; and experience shows that persons dwell- 
ing in northern latitudes, may, generally, under the 
advice of a physician, and with directions how to profit 
by its advantages, and avoid its disadvantages, derive 
great benefit from a change to a milder climate, during 
the winter season. My purpose is to give a compara- 
tive view of some of the usual places of resort. 

The climate of the Northern and Middle States 
varies so little in respect to latitude, and temperature 
in mid- winter, that a removal from one place to another 
would promise little benefit ; less, in fact, on such 
considerations, than some favored positions compared 
with others do in the same state. 

South Carolina and Georgia hold a middle rank 
between New England and Cuba, and have proved 
highly beneficial to patients from the North, who labored 
under chronic bronchitis, and bleeding from the lungs, 
and also in cases of incipient consumption. I have 
rarely, if ever, been disappointed in finding the inva- 
lids, I have sent to those places, benefited by the 
change. Aside from the favorable change of atmos- 



180 ON CHOICE OF CLIMATE 

pheric temperature, there is a satisfaction to the patient 
in knowing that the facility of communication with 
those places, enables him often to hear from home, and 
to return by land, if desirable, at any moment. Farther 
south, the most eligible place is St. Augustine, which 
is resorted to by great numbers from the North, and in 
most cases, with decided advantage. The accommo- 
dations for invalids are not so good as may be desirable, 
but they are undergoing considerable improvement, and 
all necessary comforts are obtained at a reasonable 
price. Occasionally there are sudden changes of tem- 
perature, and even severe frosts, which require more 
care and circumspection on the part of invalids, than 
are requisite in any of the West India islands ; less so, 
however, than Carolina or Georgia. 

The West Indies are resorted to during the winter 
season, by invalids from all parts of the United States, 
partly on account of their intertropical and equable 
heat, and partly on account of the frequent intercourse 
kept up with those places for purposes of trade. In 
the disordered state of the respiratory organs, which I 
have mentioned, and in more advanced stages of con- 
sumption, they generally prove beneficial. Some of 
them, however, are more eligible than others. Jamaica, 
from its size, differs from others, in presenting more 
variety of climate and scenery. Of all the small islands, 
St. Kitts, for its high, and Barbadoes, for its low land, 
are deserving of preference. A change of residence 
from one island to another is, perhaps, better than re- 
maining stationary, affording as it does the advantages 
of sailing, and variety and novelty of scene. Santa 
Cruz has the advantage of English society and customs, 
and is often selected by invalids from the northern and 
middle States. The thermometer ranges between 76° 
and 84° during the winter, and usually stands at 80°. 
The island being very small, its air is oceanic and re- 
freshing, showers are frequent, winds gentle and grate- 
ful ; and exposure to air pleasurable by day and night. 
The water is not always pure in this and many of the 



AS A REMEDY FOR CONSUMPTION. 181 

islands, rain-water being the chief supply. Milk is 
scarce and dear ; but tropical fruits are delicious and 
abundant. 

Cuba is, however, the more general place of resort 
for persons laboring under pulmonary diseases. The 
country around Matanzas is thronged by invalids dur- 
ing the winter months. Many of the permanent resi- 
dents are either American or English, as are also the 
families and servants in many of the hotels and board- 
ing-houses. The climate is mild and equable during 
the winter, but is occasionally visited by a chill from 
the north. A strong desire to render all the service in 
my power to invalids, in pursuit of health in this region, 
in the way of general as well as professional advice, 
has led me to obtain from a physician of high emi- 
nence, Dr. JohnD. Fisher, of Boston, such information 
as will interest and benefit them, from the time they 
decide on going to Cuba, till their return. I may add, 
that Dr. Fisher is particularly skilled in pulmonary 
diseases ; and having just returned from Cuba, which 
he visited for the recovery of his own health, is preem- 
inently qualified to give advice. 

" The results of my investigations, in relation to the 
influence which a permanent or a temporary residence 
in Cuba has on pulmonary consumption, lead me to 
form a favorable opinion of the remedial agency of the 
climate of that island in this serious disease. 

" The weather in Cuba from November to May, is 
uniform in its temperature, and is usually characterized 
by a pleasant and healthful degree of dryness. It is 
this, denominated the dry season, which proves particu- 
larly agreeable and beneficial to consumptive invalids. 

" The rainy season, comprising the period from May 
to October, is rather too debilitating and warm to be 
agreeable to persons of a tuberculous habit ; and yet 
those who have resided in the island for years in suc- 
cession, do not consider the rainy season calculated to 
undermine the general health, or to exert an unfavorable 
influence on tuberculous lungs. 

15* 



182 ON CHOICE OF CLIMATE 

" In answer, therefore, to your inquiry, i under what 
circumstances would it be desirable to send consump- 
tive individuals to Cuba,' I would say, that I would 
recommend two classes of phthisical invalids to visit 
that island on account of their health. The first class 
would be those who, in consequence of an hereditary 
taint, are predisposed to the disease, and who had 
shown symptoms of the existence of crude tubercles 
in the lungs ; and the second class would be those who 
have tuberculous deposits in the lungs, which tuber- 
cles may have advanced to the state of softening — 
provided this state should be confined to one lung, 
while the other lung is comparatively free from the 
disease ; and provided also that the general tone and 
functions of the digestive and other organs of the body 
are healthy. 

" Individuals of the first class, by taking up their 
residence in Cuba, before the disease has advanced 
beyond the state mentioned, and by observing, in the 
most rigid manner, the laws of health, may live and 
enjoy a comfortable degree of health there, even to an 
advanced period of life. They should engage in some 
active business, which would require them to be much 
in the open air, and to take constant and pleasant 
physical exercise. 

" In selecting a residence in the city or in the country, 
they should be particular in securing a dry and healthy 
one ; and, under all circumstances, they should guard 
themselves against the effects of a change of the weather 
from hot to cold, and against the debilitating and ener- 
vating influences of the summer and rainy season. 

" This season is much less favorable to the safety of 
the phthisical invalid, than the other portion of the year ; 
and, in consequence of its depressing influence on the 
vital powers, it is recommended that the invalid should, 
as often as every two or three years, spend the summer 
months in a northern climate ; by doing which the system 
regains its accustomed tone and vigor, and is prepared 
to withstand, for a lengthened period, the enfeebling 



AS A REMEDY FOR CONSUMPTION. 183 

influences of intertropical climate. I became acquaint- 
ed with many individuals of this class, during my stay- 
in Cuba, who had resided in the island many years, 
and who enjoyed a firmer state of health at that time 
than they had for a long period previous to their leav- 
ing the United States. 

" "With respect to the second class of consumptive 
patients who may with advantage visit Cuba, or those 
in whose lungs tubercles not only exist, but are in the 
commencing process of softening, I would remark, 
that they should arrive in the island in November, or 
after the rainy season is passed, and remain until May ; 
during which period they will experience and enjoy 
all the advantages of a uniform temperature of sum- 
mer heat. This season is usually characterized by a 
dry atmosphere, and a range of temperature from 74° 
to 82°. The heat, which otherwise would be often- 
times oppressive, is tempered by the trade winds or 
sea breezes, which blow in a gentle gale from the east 
constantly during the day. These, which are most 
agreeable in their effects on the system, sometimes 
change suddenly from the east into the north, and 
then sweep over the island, causing the mercury to fall 
rather suddenly in the thermometer as low as 68° or 
65°. This change in the temperature, and the peculiar 
chilliness of these ' Northers ' are seriously felt by 
the inhabitants, and particularly by invalids, and ren- 
der a change of clothing and even a fire necessary. 
These winds are the only circumstances which render 
a winter's residence in Cuba at all disagreeable ; and 
as they are of short duration, their unpleasant effects 
can be and should be guarded against by those whose 
lungs are invaded by tubercles, whether in a primary 
or a secondary degree. The class of patients now 
under consideration, on arriving in Cuba, should not 
remain long at the place of debarkation, but should 
seek some boarding place in the country, where they 
can have the advantage of pure air, pleasant scenery, 
and constant exercise on horseback. They should 



184 ON CHOICE OF CLIMATE 

make it a rule to rise at an early hour and ride some 
miles every morning, taking care to return home be- 
fore the heat of the sun becomes too oppressive. 
From ten o'clock in the morning, until five in the after- 
noon, they will find it more agreeable to remain within 
their cool apartments, reading, writing, or engaged in 
some pleasant amusements which require gentle exercise 
of body. After five o'clock, they can exercise again 
by riding or walking until evening. As it is important 
that the patient should have his mind constantly and 
pleasantly occupied, so that he shall even forget that 
he is an invalid, I would advise him to engage in some 
agreeable pursuits, that may divert his attention from 
his malady ; and especially would I advise that he 
should not associate with those who, like himself, visit 
the island on account of pulmonary complaints. It is 
too frequently the case, that consumptive patients in 
Cuba resort in numbers to a few boarding establish- 
ments. It would be much better for them if they 
would not thus associate. For being together, and hav- 
ing nothing to occupy then* minds during many hours 
in the day, they are naturally prone to converse on 
the subject of their maladies, and oftentimes imagine 
that they are rapidly passing to the grave. This very 
thought has an influence in depressing the vital pow- 
ers, and in hurrying on the disorder to a more serious 
stage. Patients of the class I am now speaking of, 
should, therefore, if possible, often pass from one 
place to another, and remain but a short time at 
one boarding house. In thus moving about the island, 
they will necessarily be much in the open air, and 
take the very kind of exercise which is the most bene- 
ficial. Then- minds will also be occupied by agreea- 
ble and interesting objects, and their general health 
promoted. These consumptive patients should make 
their arrangements to leave the island in the month of 
May. Those from New England should proceed 
from Cuba to some southern port, and travel leisurely, 
and not reach home till the middle or last of June, or 



AS A REMEDY FOR CONSUMPTION. 185 

until the east winds are over, and summer is fairly 
commenced. In what I have said respecting the 
classes of consumptive persons who may be recom- 
mended to visit Cuba, you will observe, that it is of 
great importance to the patient that the exact patho- 
logical state of his disease should be determined. 
Many, very many persons, are sent to the island who 
are in the last stages of the disease, and whose lives 
are shortened rather than prolonged by leaving home. 
No patient, whose lungs are more seriously diseased 
than has been indicated, should leave his home and 
friends ; and no medical man can be justified in re- 
commending him to do so. 

EUROPE. 

" The climate of the south of Europe, has for ages 
been associated in the minds of medical men with re- 
lief for pulmonary diseases. Marseilles, Montpelier, 
Hyeres, and Toulon, were formerly the resort of the 
afflicted. But these places, says a distinguished wri- 
ter, (Sweetser,) are all liable to cold dry winds from 
the north and north-west. Hyeres, situated nine miles 
east of Toulon, being sheltered from these winds by 
a range of hills, is preferable to the others. The 
place is often selected by the invalids of France, but 
the advantages of its climate are inferior to those of 
many other places, and would scarcely justify a voy- 
age to it from America or England. 

"Nice, in Piedmont, enjoys a mild warm climate, but 
for many patients it is too exhilarating and exciting. 
A lofty range of mountains shelters it from the north 
wind, but during the early spring it is unsafe on ac- 
count of the chilling north-east and east winds. The 
atmosphere is generally clear and somewhat dry. 
The thermometer during the coldest months seldom 
falls, save at night, to the freezing point ; and the 
mean temperature of winter is about 48°. It has long 
been much frequented by the English, who are suffi- 



186 OxX CHOICE OF CLIMATE 

ciently numerous in winter to form a society by them- 
selves. They reside mostly in the rear of the city, in 
a part more sheltered by the hills. They informed 
me, when I visited the city in 1820, that this part is 
decidedly better for invalids. 

" Genoa, Leghorn, and Florence, are inferior to 
Nice, as a winter residence for those who suffer from 
pulmonary affections. They however, abound in ob- 
jects of interest to travellers, particularly Florence, 
and afford agreeable and cheap accommodations. A 
few weeks' residence late in the spring may prove ad- 
vantageous. 

"Pisa is a pleasant city, situated on the Arno, which 
divides it into two nearly equal parts. The streets are 
mostly wide and straight, and handsomely paved. 
The two most beautiful of them are the Lung, and 
Arno, which are broad, quiet, and clean, extending 
along the curved and handsome quays, on one side 
bounded by the river and guarded by a wall breast 
high, on the other lined by fine ranges of lofty build- 
ings. Silence and serenity are the striking charac- 
teristics of this city, and its scenery is soft and varied. 
There are many noble structures, beside the leaning 
tower, to denote its former grandeur, when it was 
the capital of a great republic, and the residence of a 
hundred and fifty thousand inhabitants. It has a large 
English society, a botanic garden, university, exten- 
sive library, observatory, and museum of natural his- 
tory. Pisa has long had the reputation of possessing, 
for consumptive patients, one of the most favorable 
climates in Italy. Its climate is genial, but rather op- 
pressive and damp. It is softer than that of Nice, 
but not so warm ; less soft, but less oppressive than 
that of Rome. For invalids who are almost confined 
to the house, or whose power of taking exercise is 
much limited, Pisa offers advantages over both Rome 
and Nice, or any other place probably in the south of 
Europe ; and from what I saw during a visit there, I 
should prefer it to any other in a majority of cases. 



AS A REMEDY FOR CONSUMPTION. 187 

Living is cheap, and the hotels and lodging houses 
are very comfortable. The northern bank of the 
river enjoys a milder temperature during the cold sea- 
son than the opposite side, and should be preferred by 
the invalid. 

"Rome. The climate of Rome is mild and soft, but 
rather relaxing and oppressive ; in its physical quali- 
ties, Sir James Clark considers it one of the best in 
Italy. One peculiarity of it, deserving notice, is the 
stillness of its atmosphere ; high winds being of rare 
occurrence. To an invalid who is anxious for tran- 
quillity, and takes an interest in the fine arts and in 
Roman History, no place can be compared with Rome. 
The quiet and solemn majesty that pervades the city, 
the melancholy grandeur of its ruins, the pomp and 
solemnity of papal processions, all have, as it were, a 
sedative and tranquillizing effect on the mind of an 
invalid. Consumption in its early stages is generally 
benefited by this climate, especially in mid-winter, 
and it occurs less frequently here than in most other 
cities in the south of Europe, and is remarkably 
chronic in its course. It is also peculiarly favorable 
for chronic bronchitis. The water is very pure, milk 
abundant, and all the necessaries and comforts of life 
are easily and cheaply procured. The pleasantest 
lodgings are in the Piazza di Spagna, or somewhere 
in its immediate vicinity. 

"Naples, for those in health, or laboring under slight 
debility, and who require mental amusement and re- 
creation more than a mild and equable climate, is a 
delightful residence, but for consumptives it should 
certainly not be chosen for a winter abode. High 
winds prevail there more than at Rome, and those 
coming from the sea are at certain seasons keen and 
chilling. I found during a residence of summer 
months that it is cooler and more equable, excepting 
w hen the sirocco wind from Africa prevails, than 
Rome, or almost any other Italian city. This is owing 
to the cooling breeze from the West, which draws in- 
to the bay. 



188 ON CHOICE OF CLIMATE, 

" Malta is not considered a good winter residence 
for consumptive patients. 

THE WESTERN ISLANDS. 

" If required to state what place of residence appears, 
on the whole, best suited for pulmonary complaints, I 
should, from all I have been able to gather, decide in 
favor of Madeira. The mildness of the whiter and 
coolness of the summer, and slight difference of tem- 
perature between day and night, render it the most 
salubrious climate of the northern hemisphere ; ' and 
there is no place ' says Sir James Clark, ' on the con- 
tinent of Europe, where the pulmonary invalid could 
reside with so much advantage during the whole 
year.' The same author thinks, that ' were the ac- 
commodations for strangers equal at Teneriffe, and 
the means of communication between it and Madeira 
more frequent, many invalids might benefit greatly by 
passing the winter partly at Funchal in Madeira, and 
partly at Santa Cruz in Teneriffe, which is about four 
degrees further south.' 

" The Azores, situated five degrees further north, and 
further removed from any continent, enjoys a climate 
more purely oceanic, mild, humid, and equable, and 
better suited for bronchitis than even Madeira. 

" Comparing Madeira with the Canaries, and Azores, 
we find a gradual transition from the humid, soft, and 
equable climate of the Azores, to that of arid and 
rocky Teneriffe, where the want of rain during the 
greater part of the year, renders much of the island 
dry and sterile. Madeira presents an intermediate 
climate between the two, and has the advantage of a 
cooler summer than either. They all abound in trop- 
ical fruits and vegetables, of all kinds, in eggs and 
fowls, and in all the necessary comforts that an inva- 
lid requires. There is good English society, and fre- 
quent communication between them and both the con- 
tinents. 



CONCLUDING REMARKS. 189 



CONCLUDING- REMARKS. 



" I have ever felt sensibly the weight of responsibility 
that a physician incurs in deciding on the propriety 
and expediency of a sea- voyage, and change of cli- 
mate, in cases of threatened consumption. On the 
one hand it seems like banishing the sufferer from 
home and kindred for an uncertain boon ; and on the 
other it may prove a fatal error to dissuade from a 
trial of perhaps the only remedy that could benefit. 
There are also many other circumstances to be 
weighed beside the actual condition of the lungs. 
Ample pecuniary means, the feelings and habits of 
the individual, the sex, taste for travelling, and for 
mental improvement, condition and attractions of 
home, and a variety of other considerations are to be 
taken into account. Granting all these to be favora- 
ble, what are the period and circumstances in which 
benefit may be expected ? I answer, that when the 
symptoms have but recently begun to declare them- 
selves, and are slight, some trifling, not very marked 
disturbance of respiration, commencing emaciation, 
some cough, bleeding from the lungs, there is a rea- 
sonable hope of benefit, even though there be some 
purulent expectoration. Life may be protracted, and 
a repetition every winter may carry the patient along 
through the period of life most susceptible to con- 
firmed consumption. Again, if percussion and au- 
scultation show that the disease is limited to but a 
small portion of the lungs, then change of climate, 
and the sailing or journeying, one or both, necessary 
in effecting it, may assist the constitution to bear up 
under such limited disease, and prevent its farther in- 
crease. Furthermore, when the disease is manifestly 
chronic in its nature, even though the disorganization 
of the lungs be further advanced, the subject would 
probably be rendered more comfortable, and live 
longer, in a mild and equable climate, than in one 
16 



190 CONCLUDING REMARKS. 

more severe and variable. Finally, change of scene 
and the buoyancy of hope, inspired by the prospect 
of travelling, will have a salutary influence, independ- 
ently of a mere change of temperature, and this 
should induce the patient to change his residence 
often, while absent from home temporarily at least, 
rather than to continue in the same city. 

" Travelling itself should be so conducted by the in- 
valid, that neither his mind or body be overwrought. 
The former should be amused and pleasantly excited, 
but not fatigued. ' Italy, in a particular manner, so 
abounds in objects awakening the most eager curi- 
osity, and interesting associations, that there is constant 
hazard of undue mental and physical exertion. Con- 
stant sight-seeing is wearing to those in health, and 
much more so to the invalid, and may unfit the body 
for quiet rest at night. The exercise of the body too 
should be pleasantly exciting, but never exhausting, 
and not suffered to encroach on the usual hours of 
sleep.' The churches of Italy, with the exception of 
St. Peter's, are cold and damp, and should be avoided. 

" Flannel should be worn next the skin, and thick 
soled shoes, or what is better, shoes with false soles of 
cork. The patient should always have an overcoat at 
hand. He should avoid lofty mountains and the 
damps of evening — subsist on alight and nutritious 
diet — should take breakfast previous to setting out in 
the morning, and bread and milk, or macaroni and 
fruit at noon, and a plain meal about sunset, and not 
take a hearty one just before sleep. If only a predis- 
position to consumption exist, solid animal food, and 
the light wines, if they agree with the patient, may be 
taken in moderation. But when symptoms of con- 
sumption are manifest, and especially if there exists 
any inflammatory tendency, both wine and solid ani- 
mal food should in most cases be avoided. The best 
vehicle for travelling is one's own carriage, by which 
the routes, stopping places, periods of travelling and 
rest, may be adjusted to the patient's strength and 



CONCLUDING REMARKS. 191 

convenience. The diligence travels all night, and at 
a very slow pace ; the vettura is still more objection- 
able. It will be advisable to change the conveyance 
by land to water, as often as convenient. 

" Pulmonary invalids should bear in mind the advan- 
tages of sailing over those of land travelling. The 
vicissitudes of heat and cold are less during the twen- 
ty-four hours, the rolling of the vessel produces a 
sedative effect upon the pulse and lessens inflamma- 
tion, the fumes of tar emanating from the seams and 
cordage of the ship, acting upon the secretions in the 
lungs, improves the expectoration, various kinds of 
bodily and mental excitement are excluded ; and on 
the whole, so far as my observation has extended, pa- 
tients, if not annoyed by sea sickness, will in a majority 
of cases, find themselves benefited during their out- 
ward bound passage. 

" Invalids who go to tropical climates during the win- 
ter, should in most cases, return during the summer 
season. They should not return- direct to New Eng- 
land, till after the month of May ; they would do bet- 
ter to land at a southern port and approach the north 
gradually. I have known many persons complain of 
increased cough, and sometimes have bleeding at the 
lungs the moment they arrived on soundings, if pre- 
vious to the first of June." 



APPENDIX. 



Table of weights and measures employed in medi- 
cine. 



ib.j 



A pound, 
An ounce, £ 
A drachm, 5 
A scruple, 9 

The gallon, 
The pint, 
The fluid ounce, 
The fluid drachm, 



► contains * 



contains 



X1 J 
vuj 

XX 



12 ounces, § 
8 drachms, 3 
3 scruples, 9 

20 grams, gr 

eight pints, 
sixteen ounces, 
eight drachms, 
sixty drops. 



When medicines are directed in the quantities of a 
table-spoonful and a tea-spoonful, it is to be under- 
stood that the spoons are of middling size, the former 
equalling about half a fluid ounce, and the latter a fluid 
drachm. 

Sixty drops of water, one hundred drops of spirits 
and tinctures, and one hundred and twenty of alcohol, 
are equal to a drachm by measure. 

The doses, prescribed in this book, are intended for 
male adults. Boys from fourteen to eighteen are to 
take only three fourths the quantity ; from ten to thir- 
teen or fourteen, one half only. 



MEDICINE CHESTS. 

There is no part of the supplies of a merchant ves- 
sel in which such want of system exists, as in the 
medicine chest. The law of the United States, re- 
quiring a chest to every vessel over a certain size, is 



APPENDIX. 193 

so indefinite, that between the parsimony of owners 
and the imposition of apothecaries, the intention of 
the law is quite as much evaded as it would be, if the 
ocean were pointed at by the commander, when called 
upon to exhibit his medicine chest, merely because a 
sailor occasinally uses salt water as a medicine. It is 
true that there is a medicine chest on board each ves- 
sel over a certain size, and that there are medicines in 
it, and this answers all the requirements of the law. 
But let a physician, who is acquainted with the medi- 
cal wants of seamen, examine the chest, and he will 
report that bulky articles of trifling cost occupy 
most of the room, to the exclusion of other articles, 
absolutely necessary in case of sickness. The reason 
offered for this, when the apothecary is not afraid of 
offending his customers by giving it, is, that owners, 
from being in the habit of obtaining chests for certain 
sums, are unwilling to give more at the suggestion of 
an apothecary ; and that it is necessary for the chest 
to exhibit large quantities of medicine in order to give 
satisfaction. It would, however, be inconsistent with 
the fair and humane character of American merchants, 
to withhold their consent to any improvement sug- 
gested by a disinterested person, acquainted with nau- 
tical diseases. 

But the impositions most to be complained of are 
practised by foreign apothecaries, who not only put 
up wrong proportions and unnecessary kinds, but cheat 
in the price and quality of the articles. 

To correct such abuses and make medicine chests 
more uniform throughout the merchant service, the 
following list of articles is made out, with the propor- 
tions and quantity necessary for each, according to the 
size of the vessel, — and also the ordinary prices in 
the seaports of the United States. 

It is, however, to be recollected, that the price here 
given is intended for replenishing. Where a whole 
chest is put up, there should be a deduction from this 
price of from five to ten per cent. 
16* 



194 



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APPENDIX. 



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200 



APPENDIX. 



INSTRUMENTS, UTENSILS, DRESSINGS, &c. 

ARTICLES PPwOPORTIO^ED TO THE NUMBER OF THE CREW. 







$ c. 


1 $ c. 


1 $ c 


Lancets. 


No. 2 


50 


No. 2 


50 


No. 1 


25 


Penis Syringes. 


2 


25 


2 


25 


1 


13 


Bougies, small size. 


3 


36 


2 


25 


2 


25 


Gum Elastic Catheter. 


2 


50 


1 


25 






Clyster Syringe, 12 oz. 


1 


75 


1 


75 






Cotton Bandages, 12 ^ 














feet long, 3 inches > 


6 


36 


3 


18 


2 


12 


wide ) 














Patent Lint. 


4 oz. 


25 


2 oz. 


15 


1 oz. 


8 


Clean Rags. 


1 lb. 


17 


4 lb. 


10 


4 ib: 


6 


Cotton Batting, for ^ 














burns, and for dress- > 


1 lb. 


20 


i lb. 


12 






ings. j 
Adhesive Plaster, spread. 


1 yd 


36 


J yd. 


20 


iyd. 


12 


Sheep skin, for plasters. 


No. 1 


25 


A 


15 


k 


10 


Splints, for fractures. 


No. 5 


50 


4 


40 


2 


20 


Tooth drawer. 




1,00 


1 


1,00 






Curved Needles, and ") 
Waxed Threads. ) 


No. 2 


20 


2 


20 






Scales and Weights. 




1,00 




1,00 






1 Field Tourniquet. 




25 




25 






Spare phials, with corks. 


No. 4 


20 


3 


15 






Spatula. 




15 




15 






Graduated Glass. 




15 




15 






Medicine Chest and } 
Furniture. 5 




4,00 




4,00 




2,00 




11.40 




10,20 




3,31 


Medicines, 


18,09 




13,46 




7,70 




i 


£29,49 


1 


$23,66 


1 


11,01 



HOSPITAL STORES. 

Sago, 2 lbs. ; Lemon Juice ; Chloride of Lime, in a bucket, say 
30 lbs., 20 lbs., 10 lbs., according to the size of vessel. Also, Wine; 
Tea ; and Sugar ; and Fowls. Also, Opodeldoc, 1 doz. bottles. 



APPENDIX. 201 



PREPARATIONS OF MEDICINES AND DRINKS. 
DECOCTIONS, TEAS, GRUEL, &c. 

Decoction of Quassia. Take of quassia in powder 
one ounce, water one pint and a half. Put the quas- 
sia into a tin pot, and pour the water on it heated. 
Cover the vessel and boil for ten minutes. 

This decoction is given in all cases where a bitter 
tonic in considerable quantities is requisite. The dose 
is from two to four table-spoonsful. 

Decoction of Oak, Peruvian, and Cascarilla Bark, 
and of Nutgalls, may be made in the same manner. 

Barley-water. Take of pearl barley three table- 
spoonsful. First wash the barley from the mealy 
matter that adheres to it, with some cold water ; then 
boil it a little with about half a pint of water, to ex- 
tract the color ing matter. Throw this away, and put 
the barley thus purified into five pints of boiling wa- 
ter ; which is to be boiled down to four pints and 
strained. This decoction is to be used freely, as a di- 
luting drink in fevers and inflammatory complaints. 

Flax-seed tea. Take of flax-seed or lin-seed, whole 
or powdered, two table-spoonsful. Water, three pints. 
Boil one hour and strain. This is an excellent drink, 
in cases of clap or other inflammation in the urinary 
passages, and also for coughs and other inflammations. 
It may be rendered agreeable by sugar and lemon- 
juice. 

Directions for making arrow-root, also water-gruel, 
from oat-meal, flour, or Indian-meal. Take two large 
table-spoonsful of either of the above articles. Water, 
half a gallon. While the water is heating, rub the 
flour or meal, &c. in half a pint of cold water, adding 
a little at a time, then mix it with the hot water, stirring 
it at the same time, and boil fifteen minutes to half an 
hour. 

17 



202 APPENDIX. 

Toast-ivater. This is made by steeping slices of soft 
fresh bread in water, first toasting the bread till brown- 
ed thoroughly, and then putting it into the water while 
hot. When soft bread cannot be had, the hard kind 
must answer. 



SOLUTIONS. 



Solution of Cream of Tartar. To an ounce of 
cream of tartar, pour one quart of hot water, to which 
add a little loaf sugar. This is an agreeable beverage 
in fevers and inflammations, and is a mild purgative. 
It may be rendered still more agreeable by the addition 
of a little orange peel. 

Lime-water. Take of quick-lime, half a pound, water, 
three pints, mix and cover the vessel for three hours, 
occasionally shaking it ; then pour off the liquor and 
keep it in a vessel closely stopped. Its dose is from 
one-eighth to one-fourth of a pint. 

Solution of Alum, or Alum-water* Dissolve one 
drachm of alum in half a pint of water. 

Solution of Sugar of Lead, or Lead-water. Dissolve 
ten grains of sugar of lead in half a pint of water. This 
makes a good eye -water, and wash. 

Tar-ioater. Take of tar one pint, water one gal- 
lon. Boil them together fifteen minutes, frequently 
stirring them. Afterwards pour off the water for use. 
This is a valuable application for the piles. 



MIXTURES. 



Cooling' mixture. Take of Epsom salts one ounce 
and a half, nitre twenty grains, tartar emetic three 
grains, mix in one pint of water. This is a cooling 
laxative or mild purgative, and may be given in doses 
of from one to three table-spoonsful, every hour or two. 



APPENDIX, 203 

Pectoral or Cough mixture. Take of paregoric, 
two parts, syrup of squills and wine of antimony, of 
each, one part, mixed. This is an excellent mixture 
for a cough, and may be taken in doses of two tea- 
spoonsful on going to bed, accompanied by a large 
draught of flax-seed tea, or crust- water sweetened. 

Chalk mixture. Take of prepared chalk, or common 
chalk, finely powdered, two table-spoonsful, loaf sugar 
a table-spoonful, gum arabic in powder two table- 
spoonsful, water one pint, rub them well together till 
they resemble thick cream; add two tea-spoonsful of 
laudanum. Dose, a wine-glass every half hour in chol- 
era morbus. 

Effervescing mixture, Dissolve salts of tartar, half 
a tea-spoonful in two table -spoonsful of pure water. 
Then add lemon-juice, half a table-spoonful, and take 
it while it effervesces. This is valuable in some fevers. 

Dover' } s poicders. This powder will be found al- 
ready prepared at the apothecaries' shops, where it 
should be put up in doses of fifteen grains each. It 
may be mixed and taken in warm tea. It is useful in 
some cases of fever^ rheumatisms and other inflamma- 
tions. When taken, large draughts of warm tea or 
other diluting drinks should accompany it. 

Emetics, directions for taking. Mix the ipecac, or 
the tartar emetic powder in six table-spoonsful of warm 
water, and take three of them. A table-spoonful of 
the remainder is to be taken every ten minutes till 
vomiting is induced. After vomiting has commenced, 
warm water is to be drank freely after each operation. 
Should the vomiting continue too long, its operation 
may be turned downward by a draught of warm salt- 
water. Should cramp of the stomach ensue, flannels 
dipped in hot water are to be applied over it, and 
twenty or thirty drops of laudanum given. 

Cathartics or Purges, directions for taking. Scdts 



204 



APPENDIX. 



may be taken in dose of two table-spoonsfuls, dissolved 
in half a pint of warm water. 

Castor Oil, in dose of two table-spoonsful. 

Calomel and Jalap may be mixed in syrup or mo- 
lasses in a table-spoon. 

Blistering Piaster. Spread the plaster nearly as 
thin as a wafer, on soft leather, four or five inches 
square, and apply to the side, neck or other part, prev- 
iously rubbing it with spirit or vinegar. After remain- 
ing on twelve hours, or till the blister is drawn, the 
water is to be let out, and a plaster of basilicon or of 
simple ointment applied. 

The blister plaster should be preserved for use a 
second or third time* 



CATAPLASMS OR POULTICES. 

Mustard Poultice, Take pounded bread, with a 
small proportion of pounded flax-seed, boil ten or fif- 
teen minutes, and spread it on rags nearly an inch 
thick, to cover the soles of the feet, then sprinkle on 
the powder of mustard-seed, and apply as warm as 
the patient can bear. 

Emollient poultice for sores and inflammations. Take 
of Indian meal, or pounded bread, and powder of flax- 
seed, or common flour equal parts, boil them together, 
and spread the mixture more than half an inch thick 
on rags, and apply them warm. They should be re- 
newed every three or four hours. 

To preserve eggs at sea. Say about one hundred 
dozen. One bushel of stone lime, when slacked, one 
pound cream tartar, one quart of fine salt. Mix these 
with water until the mass comes to the consistency of 
thick cream, have your cask tight, cover the bottom of 
it with this material, and then place the eggs on the 
end, after having laid one tier, cover them with the 
mixture and place another tier. This will preserve 



APPENDIX. 



205 



eggs good a year. The cask should be inverted once 
in two or three weeks, to keep the yolk from settling 
down so as to touch the shell. 

Milk, how to preserve at sea. Provide a quantity of 
pint or quart bottles, (new ones are best,) they must 
be perfectly sweet and clean, and perfectly dry before 
they are used. Instead of drawing the milk from a 
cow into the pail, as usual, it is to be milked into the 
bottles. As soon as any of them are filled sufficiently 
they should be immediately corked with the best kind 
of new corks, in order to keep out the external air, 
and fastened tight with packthread or wire. Then on 
the bottom of an iron or copper boiler spread a little 
straw, on that lay a row of the bottles, and some straw 
between, to prevent their breaking, and a layer of 
straw over them, to be covered with another layer of 
bottles, till the boiler is nearly filled, then fill with cold 
water, and gradually apply heat till it begins to boil, 
when the fire is to be withdrawn. The bottles must 
remain undisturbed till quite cool, then taken out and 
packed in hampers with straw or saw-dust, and stowed 
in the coolest part of the ship. Milk thus preserved 
may cross the Atlantic and return as sweet as when 
first drawn from the cow. \N. E. Farmer, 1835. 

For making Spruce Beer. Take three gallons of 
water, blood warm, 1| pint of molasses, 1 table-spoon 
of essence of spruce, 1 do. of ginger. Mix well to- 
gether, and add one gill of yeast. Let it stand over 
night and bottle it in the morning. 

To preserve cabbages, Sfc, fresh during a voyage. 
Cut the cabbage so as to leave about two inches or 
more of the stem attached to it ; after which scoop 
out the pith to about the depth of an inch, taking care 
not to wound or bruise the rind. Suspend the cab- 
bages by means of a cord, tied round the stem, so 
that that portion of it from which the pith is taken, 
remain uppermost, which regularly fill every morning 
with fresh water. By this simple method, cabbages, 
17* 



206 



APPENDIX. 



cauliflowers, &c, may be preserved fresh during a 
long voyage. 



CHLORIDE OF LIME. 



This disinfectant and purifier of both air and water, 
should be supplied for every vessel, large and small, 
more especially if destined to warm latitudes. 

Chloride of lime is a greyish white powder, varying 
in strength, and becoming moist by exposure to air. 
When very pure, it is nearly all soluble in water, and 
may be sprinkled upon the floor of any foul apart- 
ment, when it will soon remove offensive smells arising 
from animal or vegetable putrefaction. The addition 
of a small quantity of diluted sulphuric acid will evolve 
its virtues with double rapidity. To one gallon of water, 
add a pint of bleaching powder and an ounce of elixir 
vitriol, and it will be of a proper strength for correct- 
ing the putrid smells of apartments, and of animal 
putridity. The same effect will result without the 
acid, but will require more time. It is much used in 
privies, and docks, where the powder itself may be 
sprinkled. The solution may be sprinkled between 
the timbers in the hold of a ship, and on the berth- 
deck, on hammocks and in berths. Foul ulcers and 
wounds may have their dressings wetted, and it may 
be sprinkled on the surface of a dead body which it is 
desirable to preserve on board for interment on shore, 
or some of the powder may be thrown into the coffin. 

It may be advantageously used for purifying offen- 
sive water, a property which makes it invaluable in 
long voyages. For this purpose, from one to two 
ounces of the powder may be mixed in sixty-five gal- 
lons of water. After the purification is effected, the 
water must be exposed for some time to the ah*, and 
allowed to settle before it is fit to drink. 

The best way to carry chloride of lime is in covered 
buckets. 



APPENDIX. 207 



FUMIGATIONS. 



The forecastle and other lodging apartments of a 
merchant vessel should be fumigated as often as prac- 
ticable, and especially in hot climates. One of the 
most simple is the 

Vinegar Fumigation. Immerse a hot iron in vine- 
gar, at the same time closing the hatches. 

Another. Sulphuric acid, or oil of vitriol, sal nitre, 
or saltpetre, of each one ounce. 

This quantity is sufficient for an apartment twenty 
feet square. 

The sulphuric acid is placed in a glass or china ves- 
sel, and the nitre gradually added : in order to have 
an abundant extrication of nitrous fumes, it is neces- 
sary to raise the temperature of the acid by means of 
a lamp, or by placing it on hot sand. 

This air may be respired with perfect safety, and 
even with advantage in fevers ; it should therefore, al- 
ways be preferred where the sick remain in the room. 



VACCINATION. 



Every captain bound on a long voyage, should see 
that his men are secured, before sailing, against small 
pox. 

If he chooses, he can vaccinate them after leaving 
port, but in taking virus with him for this purpose, he 
should remember that it will not keep on quill points 
at sea but a very few days. A piece of scab hermet- 
ically sealed in a glass bulb or very small phial may 
keep three months. Signs of vaccination having taken, 
will be apparent about the fifth day. 



208 APPENDIX. 

THE LAW RELATING TO MEDICINE CHESTS. 

" Every vessel of one hundred and fifty tons or upwards, navi- 
gated by tenor more persons in all, and bound on a voyage beyond 
the United States, and every vessel of seventy-five tons or up- 
wards, navigated by six or more persons in the whole, and bound 
from the United States to any port in the West Indies, is requir- 
ed to have a chest of medicines, put up by an apothecary of known 
reputation, and accompanied by directions for administering the 
same. The chest must also be examined at least once a year, 
and supplied with fresh medicines. 

" In case of dispute, the owner must prove the sufficiency of 
the medicine chest. It does not lie with the seaman to prove its 
insufficiency. 

" If a vessel has a suitable medicine chest on board, it would 
seem that the ship is not to be charged with the medicines and 
medical advice which a seaman may need. But the ship is still 
liable for the expenses of his nursing, care, diet, and lodging. 
Accordingly, if a seaman is put on shore at a hospital or else- 
where, for his cure, the ship is chargeable with so much of the 
expense as is incurred for nursing, care, diet, and lodging ; and 
unless the owner can specify the items of the charge, and show 
how much was for medical advice, and how much for other ex- 
penses, he must pay the whole. The seaman is to be cured, at 
the expense of the ship, of a sickness or injury sustained in the 
ship's service ; but if he contracts a disease by his own fault or 
vices, the ship is not chargeable. A sick seaman is entitled to 
proper nursing, lodging, and diet. If these cannot be had, or are 
not furnished on board the vessel, he is entitled to be taken on 
shore to a hospital, or to some place where these can be obtained. 
It is often attempted to be shown, that the seaman was put on 
shore at his own request. This is no defence. He is entitled to 
be put on shore if his disease requires it ; and it is seldom that 
proper care can be taken of a seaman on board ship. 

" If a seaman requires further medicines and medical advice 
than the chest and directions can give, and is not sent ashore, it 
would seem that the ship ought to bear the expense ; but this 
point has never been decided. If the medicine chest can furnish 
all he needs, the ship is exempted." — Dana's Seaman's Friend. 



INDEX. 




Abscess, bow to open 


131 


Acute Rheumatism 


104 


Africa, diseases on the Western shore of 


170 


Ague and fever 


9 


Amputation . 


131 


of the arm .... 


132 


fingers and toes 


134 


Anchorage in sickly ports to be changed 


141 


Angina, or Quinsy 


49 


Ankle, dislocation of 


111 


Anthony's fire, St. 


118 


Apoplexy 


40 


Application of leeches 


130 


Arm, dislocation of ..... 


109 


amputation of . . 


132 


bloodletting from 


129 


fracture of ...... 


114 


Arteries, wounds of ..... 


123 


Ascites, or dropsy of the belly .... 


68 


Asthma ........ 


66 


Barley-water, how to make .... 


201 


Beer 


205 


Bellyache, or colic ...... 


80 




67 


dropsy of ...... 


68 


Bilious colic 


80 


fever 


12 


remittent fever 


12 


Bite of snakes, vipers, &c. .... 


126 


Bladder, inflammation of 


90 


Bleeding, how to stop, in wounds 


121 


at the nose 


47 


how to perform in the arm 


129 


how to perform in the foot 


130 


Blister, directions for applying and dressing 


204 


Blood-letting 


129 


Blood, spitting of 


63 






Bloody urine 


91 


flux. See Dysenteria .... 


82 



210 



CONTENTS. 



at sea 



Bones, fractures of ... 

the nose 
the arm .... 

the clavicle or collar bone 

the lower jaw 

the elbow 

the fingers and hand 

the knee (palm bone) 

the leg . . 

the ribs 

the thigh .... 
Bowels, diseases of 
Bougies, how to introduce 
Brain, fever or inflammation of 

Bread. See Diet 

Bread, how to provide yeast for 
Bronchitis, chronic 
Bruises or contusions 

ulcers from 
Bubo, venereal .... 

Burns and scalds 
Butter, how to preserve sweet 
Cabbages and Cauliflowers, to preserve 
Catarrh or cold .... 

Catheter, how to introduce 
Chancre, venereal .... 
Chest, diseases of ... 

dropsy in .... 

Chilblains or frozen limbs 
Chloride of lime .... 

Cholera, Asiatic or Spasmodic 
Cholera Morbus 
Chordee . 

Chronic Bronchitis 
Rheumatism 
inflammation of the liver - . 

Clap 

Climate, choice of, in consumption 
Clothing, directions concerning 
Clysters, how to administer 
Cold or Catarrh 

Colic 

Collar bone, fracture of 
Consumption .... 

choice of climate in 
Contusions or bruises 

Contagion, means to prevent the spreading 
Convulsions or epileptic fits 



of 



CONTENTS. 



211 



Cough 

Cramp of the stomach ..... 

Coup de soleil, or stroke of the sun 

Croup 

Cuts ........ 

Diarrhoea or looseness 

from water of the Neva 
Diet, directions concerning .... 

Directions for preserving fresh meat 

for the prevention of disease among seamen 
Diseases on the Western shore of Africa 
the coast of England 
United States .... 

East Indies .... 

Mediterranean . . . 

West Indies .... 

Diseases of hot climates, directions for preventing 
cold climates, directions for preventing 

the head 

the throat 

the chest 

the belly 

urinary organs and genitals 
limbs and large joints 

skin 

fundament .... 

Dislocations of the lower jaw .... 
shoulder .... 
elbow .... 

palm-bone of the knee 

thigh 

knee-joint 

ankle 

fingers and toes 
Dress in warm climates . . . 

cold climates 

Dressings for chancres. See Chancres 
buboes. See Buboes 
sores and ulcers .... 

blisters 

Dropsy, general 

of the belly 

chest ...... 



scrotum 
Drowned persons, means of recovering 
Dry bellyache .... 

Dysenteria 

Dyspepsia or indigestion 



65 
190 
44 
51 
121 
81 
82 
152 
153 
161 
170 
169 
163 
177 
169 
164 
161 
149, 162 
45 
49 
56 
67 
89 
104 
118 
85 
108 
109 
109 
111 
110 
111 
111 
112 
160 
161 
98 
102 
126 
204 
34 
68 
66 
104 
127 
80 
82 
36 



212 



CONTENTS. 



Earache 


49 


Eggs, how to preserve at sea .... 


204 


Elbow, fracture of 


115 


England, diseases on the coast of ... 


169 


Epilepsy 


38 


Erysipelas, or St. Anthony's fire .... 


118 


Eye, inflammation of 


46 


Falling down of the fundament .... 


87 


Feet, frozen 


125 


Fevers, intermittent or fever and ague 


9 


bilious remittent 


12 


low typhus or slow nervous 


15 


putrid, malignant, jail or ship 


17 


yellow 


22 


acute or inflammatory . 


27 


Fistula 


87 


Fingers, amputation of ....... 


134 


fractures of ...... 


116 


dislocation of 


112 


Fits, epileptic 


38 


apoplectic ....... 


40 


Flax-seed tea, how to make ..... 


201 


Fractures, general remarks on 


112 




114 


nose 


113 


clavicle or collar-bone 


113 


lower-jaw . 


113 


elbow 


115 


hand and fingers . 


116 


knee, palm-bone of ... 


118 


leg 


117 


ribs ...... 


114 


thigh 


116 


Fresh meat, how to preserve .... 


153 


Frost-bitten limbs . 


125 


Fruit in hot climates, bad effects of ... 


144 


Fumigation . 


19, 146 


Fumigation of ships 


207 


Fundament, diseases of. See Piles, Fistula, and 




falling down of the fundament 


87 


Gleet 


96 


Gonorrhoea ........ 


93 


Groin, rupture in, or Hernia 


S8 


Guinea worm ....... 


127 


Gunshot wounds 


123 


Guts, diseases of 


74 


Headache . . . ... 


48 


Head, fever of 


44 



CONTENTS. 



213 



Health, directions for preservation of . 
Haemorrhoids, or piles 


136 
85 


Heart-burn 


...... • 


74 


Heat, prickly 
Hernia or rupture 





120 

88 


Hospital stores 


...... 


200 


Indigestion 


....... 


36 


Incised wounds 


. • . • ... 


121 


Inflammation of the 


eye . . 


46 




brain . . . . 


44 


-" 


intestines or guts 


74 




bladder .... 


90 




liver 


69 




lungs, or pleurisy 

kidneys .... 

stomach .... 


56 
89 

72 


Inflammatory fever 
Intermittent fever 


throat, or quinsy 


49 

27 

9 


Intestines, diseases of 


74 


inflammation of .... 


74 


Introducing bougies 


...... 


134 


the catheter 


135 


Itch 


...... . 


119 


Jaundice 


...... 


33 


Jaw, locked, or tetanus 


41 


fractured 


• • • . . • 


113 


dislocated 


....... 


108 


Knee, disjointed 


...... 


111 


Kidneys, inflammation of 


89 


Lacerations 


...... 


123 


Laryngitis 


. . . . . . . 


51 


Law relating to Medicine Chests .... 


208 


Leeches or blood-suckers, how to apply 


130 


Leg, fracture of 


....... 


117 


Letting blood, direct 


ions for . 


129 


Limbs and joints, di 


seases of .... 


104 


Limbs dislocated or 


disjointed .... 


108 


fractured or broken 


112 


frost bitten 




125 


Lime juice, the importance of in long voyages 


152 


Lime water, how to 


make .... 


202 


Linseed tea, how to 


make 


201 


Liver, disease of 


...... 


69 


Looseness 


• . • . . 


81 


Locked-jaw 


.... 


41 


Lumbago. See Rheumatism .... 


104 


Lungs, inflammation of, or Pleurisy 


56 


18 





214 



CONTENTS. 



Lungs, consumption of ... 

Measles ...... 

Meat, fresh, how to preserve 
Measures and weights, table of 
Mediterranean, diseases on the shores of . 
Medicine chest, contents and price of 

law relating to 
Medicines, directions for mixing and taking 
Milk, to preserve at sea 
Mercurial course. See Syphilis and Bubo 
Morbus, cholera ..... 

Mumps ...... 

Nervous fever. See Typhus 

Nettle Rash 

Nose, bleeding from .... 

fracture of .... 

Operations 

Ophthalmy, or sore eyes 

Palm-bone of the knee, dislocation of 

fracture of 
Paraphymosis ..... 
Penis, diseases of 

Phthisis pulmonalis, or consumption 
Phvmosis 

Piles .... 

Pleurisy 
Pneumonia 
Poisons, swallowed 
Poisonous fish 
Pox, small 

venereal 
Preservation from disease when wooding and waterin 

of health of seamen 
Preparation of medicines 
Prevention of diseases in tropical climates 

cold and temperate climates 
Preventing the spreading of diseases in a crew 
Putrid fever 

sore throat 
Quinsy, or sore throat 
Rash, nettle 
Ratio of mortality of British troops, in the British West 

India Islands ...... 

Ratio of mortality in the United Kingdom, Mediterranean, 

and in the African colonies .... 

Remittent fever ....... 

Resuscitation of drowned persons .... 

Rheumatism, acute 



167 

176 

12 

127 

104 



CONTENTS. 



215 



Rheumatism chronic 
Ribs, fracture of ... 
Running, or Clap .... 

Rupture, or Hernia .... 
Salt water, how to freshen 
Scalds and burns .... 
Scalding of the urine .... 
Scarlet fever .... 

Scrotum, dropsy in .... 

Scurvy ..... 

Seaports, different times of sickness in 
Seasons of sickness in different countries 

Sea sickness 

Serpent, bite of .... 

Sickly country, signs of ... 

Signs of an unhealthy country 
Shoulder, dislocation of 
Skin, diseases of ... 
Sleeping on deck to be avoided 
Small pox ..... 

Snake, bite of 

Sore throat, or quinsy 

putrid .... 

Sores or ulcers . . . 

Spitting of blood .... 

Sprain ...... 

Stabs 

Stomach, diseases of ... 

inflammation of 

pain of 

sour 

St. Anthony's fire 

Stoppage of the urine 

Stroke of the sun .... 

Strangury, or stoppage of urine 

Stricture in the urinary passage 

Sun, stroke of .... 

Suppression of urine 

Swelled testicle .... 

Syphilis or venereal 

Table of weights and measures 

Testicles, swelled .... 

Tetanus, or lockjaw .... 

Thigh, fracture of ... . 

Throat, diseases of .... 

sore .... 

Thumb, dislocation of ... 

Toes, dislocation of ... 



106 

114 

93 

88 

157 

124 

94 

54 

104 

30 

162 

178 

70 

126 

147 

147 

109 

118 

144 

42 

126 

49 

54 

126 

63 

108 

124 

72 

72 

72 

74 

118 

92 

44 

92 

97 

44 

92 

103 

98 

192 

103 

41 

116 

49 

50 

112 

112 



216 



CONTENTS. 



Toothache .... 

Tourniquet, how to apply 

Tumors, how to open 

Tympany, or windy dropsy 

Typhus fever, low 

Ulcers ...... 

Unhealthy country, signs of 
Unhealthiness, seasons of 
Urinary organs, diseases of 
Urine, stoppage of ... 

bloody, discharge of . 
incontinency of 
Urethra or urinary passage, stricture of 
Vaccination 

Venereal disease or pox 
Venomous creatures, bites of 
Ventilation of ships 
Viper, bite of .... 

Vomiting of blood 
Vomiting from sea sickness 

and purging 
Water in the belly .... 

chest 
scrotum 
Water-gruel, how to make 
Water, how to purify 

how to correct its purgative qual 
sail, how to freshen 
Weights and measures 
West Indies, diseases of 
Wind colic 
Windy dropsy 
Worm, Guinea 
Wounds 

of arteries . 

bruises 

gunshot 

incised or cut 
Yeast, how preserved for sea 
Yellow fever 



ty 



48 

121 

131 

67 

15 

126 

147 

178 

89 

92 

91 

92 

97 

207 

98 

126 

151 

126 

73 

70 

75 

68 

66 

104 

201 

157 

82 

157 

192 

164 

80 

67 

127 

121 

123 

123 

123 

121 

154 

22 



- From page 185 to page 191, was written by the author of the' work, and not by Dr. Fisher, 
as the misplaced quotation marks would indicate. 



THE END. 



